
, j 












.; 






■ 






- 












->. 









^ 
















: 












































































.# 




, ^5- g ^ ^ 



... <- -^ 












% 



V* N ' 



<s -v 



1, 



PHYSIOLOGICAL PYRETOLOGY; 



a me&ifese on i?^vaisi£s 



ACCORDING TO THE PRINCIPLES 



OP THE 



NEW MEDICAL DOCTRINE. 



F. G. BOISSEAU, 



DOCTOR IN MEDICINE OP THE FACULTY OF PARIS, MEMBER OF THE ACADEMIES OF MEDICINE OP 

PARIS AND MADRID, OF THE MEDICAL SOCIETY OF EMULATION, OF THE PHYSICO-MEDICAL 

SOCIETY OF MOSCOW, OF THE SOCIETIES OF MEDICINE OF BRCSSELS, LOUVAIN, 

MARSEILLES, METZ, AND TOURS, AND OF THE SOCIETY OF AGRICULTURE 

OF CHALONS. 







Novi veteribus non opponendi, sed quoad fieri potest, perpetuo jungendi fcedere.— Baglivi. 



FIRST AMERICAN, FROM THE FOURTH FRENCH EDITION. 

TRANSLATED 

BY J. R. KNOX, M. D. 




CAREY & L.EA, 

1832. 



Estered according to the Act of Congress in the year 1832, by Caret & 
Lea, in the District Court for the Eastern District of Pennsylvania. 



nif. 



PRIKTEE?. 



PREFACE. 



To dissipate the prejudices entertained by some phy- 
sicians against the application of pathological anatomy 
and physiology to the investigation of the seat and na- 
ture of fevers; to contribute to the dissemination of 
truths, the value of which can no longer be contested, 
since they have given rise to a more rational, and, what 
is of greater importance, a more efficacious treatment of 
these diseases; to show that, if the French medical doc- 
trine is new, when considered as a system, it can, never- 
theless, appeal in attestation of its truth to the authority 
of past ages, and even to the experience of its adversa- 
ries ; finally, to reduce within the limits of observation, 
principles which have been generalized with too much 
boldness. Such were the objects which I proposed to 
myself in the publication of this work, which first ap- 
peared in 1823. 

This edition has received numerous additions, which 
principally refer to the anatomical researches recently 
made, with a view to throw light on the nature and seat 
of various fevers, to quarantines, and the epidemics of 
the Morea and Gibraltar. In consequence of the em- 
ployment of a smaller type, the size of the volume has 
not been increased. 

Having been induced by the continued favour of the 
public^ to believe that this work had not been devoid of 
utility, the only reward which a scientific author can 



iv PREFACE. 

propose to himself, I undertook to publish a work of 
greater extent, in which I applied to pathology * in ge- 
neral, the method and principles by which I had con- 
ducted my researches on fevers. 

I do not aspire to the celebrity of a reformer ; my ob- 
ject is simply to offer students and practitioners, who 
have not an opportunity of following the progress of me- 
dical discovery, a faithful exposition of the present state 
of the science of disease, in reference to diagnosis and 
treatment. The observations of the ancients and mo- 
derns have furnished the elements of this work, which 
is designed as an introduction to that attentive and pro- 
found study of the science and art of curing, which it 
is the duty of every physician to prosecute. 

Paris, November 2,7th, 1830. 

* Nosographie Organique ou Traite complet de Medicine. Paris, 1828, 
1830, 4 vols, in 8vo.; chez J. B. Balliere. 



TABLE OF CONTENTS. 



Preface Page 3 — 4 

Introduction. General principles of physiology and pathology. Sect. 1 . Of 
life and organization. Sect. 2. Of the human body. Sect. 3. Of organic 
action. Sect. 4. Of excitability. Sect. 5. Of organic action in the state of 
health. Sect. 6. Of organic action in the state of disease. Sect. 7. Of sur- 
excitation or irritation. Sect. 8. Of sub-excitation or astheny. Sect. 9. Of 
organic action considered with relation to therapeutics. - - Page 9 — 56 

PHYSIOLOGICAL PYRETOLOGY. 
CHAPTER I. 

OF FEVERS IN GENERAL. 

Hippocrates did not entertain the opinions since held on the subject of fevers. 
Symptomatic pyretology. The characteristic signs of fevers. Enumeration 
of the different fevers described by pyretologists. Type, duration and termi- 
nation of fevers. Errors of the pyretological doctrines before Pinel. Service 
rendered to science by Pinel. The perfecting of nosographic pyretology to 
be ascribed to him. Necessity of commencing where he terminated, in treating 
of fevers. Object of the author and plan of the work. Principles of M. Brous- 
sais, in relation to the seat of diseases in general, and the nature and seat of 
fevers in particular. Arguments in favour of their adoption. Arguments 
against referring all fevers to gastro-enteritis. Opinion of the author on the 
seat of fevers. This work is not polemical. - - . Page 57 — 68 

CHAPTER II. 

OF INFLAMMATORY FEVER. 

Synonym. Premonitory symptoms. Symptoms. Course, duration, complica- 
tions and terminations. Varieties. Nature and seat. According to Pinel. 
According to M. Broussais; Tommasini; Reil; Bagard; Brown; J. P. Frank; 
M. Bouillaud; M. Gendrin; The Author. Causes; Synocha is not always a gas- 
tro-enteritis. Inflammatory fever arising from encephalic irritation; from car- 



VI CONTENTS. 

dlac; gastric; bronchial; mammary; uterine; renal; vesical; cutaneous; arti- 
cular: epidemic inflammatory fever of 1802. These diverse irritations com- 
bined, may determine symptoms of inflammatory fever. 

Treatment of Inflammatory Fever. 

Principles which should guide us in the treatment, founded upon the nature 
and seat of this disease. General indication. Of blood-letting". Answer 
to the objections against leeches. Of cupping; diet; drink; pediluvia; rube- 
facients; emetics and cathartics. The treatment should be the same in epide- 
mic inflammatory fever. Are there cases in which the inflammatory fever 
should be abandoned to the efforts of nature. Treatment during convalescence. 
Treatment of complicated inflammatory fevers. - - - Page 69 — 107 

CHAPTER III. 

OF GASTRIC FEVER. 

Synonym. Precursory signs. Symptoms of gastric embarrassment. Of intesti- 
nal embarrassment. Of gastro-intestinal embarrassment. Of gastric fever. 
Course, duration, complications, and terminations of these affection. Of gas- 
tric inflammatoiy fever. Pathological anatomy. Symptoms of cholerar. Pa- 
thological anatomy. Nature of these affections, according to Galen; Tissot; 
Finke; Selle; Stoll; Frank; Brown; Fordyce, and Pinel. Nature and seat, ac- 
cording to MM. Tommasini and Broussais. Causes. Variety of gastric em- 
barrassment, with which it is important to be acquainted. First variety of gas- 
tric fever; second variety; third variety; fourth variety. Relative frequency 
of these varieties. Encephalic symptoms in gastric fever. Pectoral symptoms 
in gastric fever. Of the pretended utility of vomiting, diarrhoea and a flux of 
urine in gastric fever. Prognosis. Pathological anatomy. In the horse. 

Treatment of Gastric or Bilious Fever. 

Of indigestion. Treatment of indigestion. Affinity between indigestion, gas- 
tric embarrassment and gastric fever. Treatment of gastric fever since Hip- 
pocrates. According to Tissot, Stoll and Pinel. Fundamental principles 
which should, at the present day, direct the treatment of gastric affections. 
Treatment of a slight irritation of the stomach. Of a more intense irritation, of 
the degree of irritation which constitutes the ardent fever of the ancients, or of 
inflammatoiy gastric fever. Of leeches, drinks, water. Quantity and tempe- 
rature of drinks. Of diet. Of emulsions; fomentations; lavements; measures 
indicated by the signs of encephalic irritation. Course to be pursued when 
the irritation extends to the liver. Case in which an emetic is allowable. Stoll 
thought the patient should be prepared by blood-letting, for the operation of 
an emetic. What is meant by the salutary shock produced by an emetic? 
The melioration of the symptoms after an emetic, is generally only momentary. 
Purgatives. Treatment of diarrhoea. Of the irritations which supervene on 
that of the gastric mucous membrane, and complicate it Of anomalous bilious 



CONTENTS. Vll 

fevers described by Finke. Epidemic gastric fevers, require no other treat- 
ment than those which are sporadic. Purgatives during- convalescence. Means 
of preventing- relapses. Disadvantages of tonics. - - Page 108 — 138 

CHAPTER IV. 

OF MUCOUS FEVER. 

Synonym. Precursory signs. Symptoms. Of the presence of worms. Course 
duration, complication and terminations. Results of-autopsy according to Roe 
derer and Wagler; according" to Sarcone. Causes, nature and seat. Worms. 
Complicated mucous fever is not always solely the result of gastro-enteritis 
Complication. Treatment of mucous fever. General idea of mucous fever 
which should guide us in the treatment. Treatment recommended by Selle, 
Stoll and Frank; by Roederer and Wagler, and by Pinel. Therapeutic indica- 
tions derived from its nature and seat. When the signs of gastro-intestinal irri 
tation are very prominent. When they are not very prominent. Opinion of 
Sarcone with regard to blood-letting: of Roederer. Emetics. Measures to 
be taken when the disease is prolonged; when there is diarrhoea, dysentery, 'or 
bronchial irritation. Page 139 — 160 

CHAPTER V. 

OF ADYNAMIC FEVER. 

It is the creation of modem times. The opinions of Selle, Stoll, Cullen and 
Frank, with regard to putrid fevers. Character of the adynamic fever accord- 
ing to Pinel. Symptoms of this fever. Physiological analysis of all the symp- 
toms. Conclusion. Causes to which this fever is attributed. Physiological 
analysis of the action of these causes. Quarin distinguishes five kinds of pu- 
trid fever. Experiments of MM. Gaspard and Magendie. Does astheny of 
the brain occur in adynamy? Precursory signs. The adynamic fever is not 
the result of weakness. First variety of this fever; second variety; third vari- 
ety. Nature and seat^of adynamic fever: course, duration and termination. 
Unfavourable signs. Results of autopsy, according to Pinel; M. Prost; M. 
Broussais and the Author. Objections urged against the importance of orga- 
nic alterations detected after adynamic fever. Answers to these objections. 
Result of the anatomical researches of M. Andral; of Laennec; of M. Ribes. 
Recent conclusions of M. Andral. Researches of M. Louis. 

Treatment of Adynamic Fever. 

It is seldom cured, especially when it is treated by tonics. Tonics and emetics 
are contra-indicated by the nature of this fever. The prescription of tonics 
in this fever, founded solely upon hypothesis. Botalli; Gui; Patin: Hecquet; 
Chirac; Baglivi; Van Swieten; Dehaen; Sydenham; Huxham and Stoll, were 
aware of the bad effects of these measures. Brown used them prodigally. 
MM. Rasori and Tommasini commenced a reform. It was in France that the 
problem of the nature of adynamic fever, was definitively solved, and from 
that period the treatment of these fevers has reposed upon a solid basis. Hy- 

B 






Vlll CONTENTS. 

gienic measures against the development of these fevers. Measures proper on 
some occasions, on the part of the government. Blood-letting- does not con- 
vert inflammatory into adynamic fever. Bad effects of emetics administered 
with a view to prevent adynamy. Adynamic fever uncommon in the establish- 
ments in which fever is treated by blood-letting. Good effects of the anti- 
phlogistic treatment, witnessed by the author in the practice of M. Broussais. 
Proper course when adynamy has declared itself. When there still exist une- 
quivocal symptoms of inflammation. When the symptoms of adynamy alone 
appear to remain. When we are called to a patient in whom the symptoms 
are said to have manifested themselves suddenly, or about whose case we can 
obtain no information. When the case is almost hopeless. If there are cases 
.in which tonics may be useful; these cases are rare, and they are exceptions to 
the general rule, and must not be considered as constituting this rule. Of to- 
nics in convalescence. Attention to be paid to the skin in this disease. Of baths. 
Of sinapisms. Of blisters. Of the treatment of ulcerations. Of dryness of 
the mouth, and of drinks. Of constipation and lavements. Of meteorism and 
cold fomentations. Of hemorrhage and astringents. Of sweats. Attentions 
during convalescence. Treatment recommended by M. Louis. Page 161 — 237 

CHAPTER VI. 

OF ATAXIC FEVER. 

Synonym. Course pursued by Selle and Pinel in establishing the order of ataxic 
fevers. Symptoms of ataxic fever. Nervous symptoms of those fevers. Di- 
vision of those symptoms into two series. First series. Second series. Nei- 
ther of these series indicate weakness. Signs of irritation of the arachnoid 
and encephalon, according to Lallemand. Result of the researches of MM. 
Bouillaud, Foville, Pinel Grandchamp, Lacrampe, Lousteau, Parent, and Mar- 
tinet — Of M. Senn. Gastric symptoms of ataxic fever. They are the result 
of irritation. Their absence and inference to be drawn from it. Circulatory 
symptoms of ataxic fever. They do not prove that it is owing to weakness or 
ataxy. State of the skin in this fever. Of ataxy. Signs of ataxy according 
to Selle. Varieties of ataxic fever which it is important not to confound. 
First variety; second, third, fourth, fifth, sixth, seventh, eighth. Termination. 
Unfavourable signs. Results of autopsy. Nature and seat of ataxic fever ac- 
cording to the author. Causes of ataxic fever. Physiological analysis of the 
action of the causes. All ataxic fevers are not gastro-enterites. Definition of 
ataxic fever according to the author. 

Treatment of Maxic Fever. 

Danger of tonics in these fevers. Services rendered to medicine by M. Broussais. 
Indications to be fulfilled with a view to prevent ataxic fever, — to cure it; ge- 
neral method; blood-letting, in plethoric subjects, in subjects more nervous than 
sanguine, in subjects suffering from exhaustion. Tonics, emetics, cathartics. 
Modifications of the treatment in cerebral fever, in ataxic inflammatory fever; 
hi gastro-ataxic fever, in ataxic mucous fever, in slow nervous fever. 

Page 238—271 



CONTENTS. IX 

CHAPTER VII. 

OF TYPHUS. 

Signification of this word according- to Hippocrates, Galen, Sauvages, Pringle, 
Cullen, Hildenbrand, Pinel. The latter has expressed two contradictory opi- 
nions with regard to the nature of typhus in his nosography. History of the 
typhus of Rochefort, described by Chirac. Results of autopsy. History of 
the typhus, described by Pringle. Results of autopsy. History of the ty- 
phus of Salpetriere, described by Pinel. Results of autopsy. General de- 
scription of typhus, according to Hildenbrand. Of regular typhus. Descrip- 
tion of irregular typhus. Results of autopsy, according to Hildenbrand. This 
author contradicts himself. Services rendered to science by Chirac, Pringle, 
Poissonnier Desperrieres, Pinel, and Hildenbrand. Inference drawn from a 
physiological analysis of their works. What typhus is, according to the author. 
Proofs of the truth of this opinion derived from the work of Hildenbrand. 
Opinion of M. Broussais on the nature and seat of typhus. According to him, 
typhus is not a disease sui generis. He has not dwelt sufficiently on the con- 
stancy of cerebral irritation in typhus. Typhus, according to Hildenbrand and 
Pinel, is a peculiar disease. This speciality is not demonstrated by pathologi- 
cal anatomy; it is not to be found in the symptoms or in the causes. The stu- 
por does not prove it, nor the mode of propagation. How typhus, caused by 
miasmata, differs from sporadic typhus. Of petechia, of inflammation of the 
parotid gland, of phlegmon, of tumefaction of the inguinal glands; of gan- 
grenous spots, and of carbuncles. What these symptoms indicate: how their 
appearance may be explained. Hildenbrand has properly remarked, that an 
absorption of miasmata is not essential to the production of typhus. To what 
distance can the miasmata and effluvia which generate typhus, be transported? 
Of the agents of its propagation. Of the causes of typhus other than mias- 
mata. On what organ do the miasmata principally act? The skin is not the 
only organ to be guarded against their impression. Of the general measures 
to be employed with a view to prevent the development and propagation of ty- 
phus. 

Treatment of Typhus. 

Theoretical views of Chirac on the treatment of typhus: in what his method con- 
sisted. Precautions taken by him in the employment of blood-letting. He 
abused emetics and stimulants, and advised at the same time, to prevent with 
care the inflammation of the stomach and intestines, of the brain and liver. 
Method of Pringle in the treatment of typhus. It was vague, founded upon 
a defective theory, and not upon experience. Prejudices of Pringle against 
blood-letting. Poissonnier Desperrieres, only pursued the footsteps of Pringle. 
Method of Pinel in the treatment of typhus. Is it proper to administer 
tonics and emetics in the first twenty-four hours? How Hildenbrand treat- 
ed himself when he had the typhus. How Pinel treated himself under simi- 
lar circumstances. Singular confession of Hildenbrand. Method of Brous- 
sais in the treatment of typhus. Superiority of this method. Why blood- 
letting is of so little efficacy in typhus. - - - Page 272—313 



X CONTENTS. 

CHAPTER VIII. 

OF YELLOW FEVER. 

It Las been referred to every species of continued fever, with the exception of 
mucous fever. General description of the symptoms of this fever. Premoni- 
tory signs. First period, second period, third period. Duration. State of 
the intellectual faculties. Convalescence. Of the symptoms observed in yel- 
low fever more frequently than in any other disease, and of those which con- 
stantly occur in this fever. Of the black matter; of icterus; of vomiting-; of 
epigastric pain: of pain in the head; of pain in the loins, and in the back of 
the neck. Do these symptoms authorize us to regard the yellow fever as a 
disease essentially different from even- other. Results of post mortem exami- 
nations in America; at Barcelona: at New Orleans. Important researches re- 
main to be made with regard to this disease. Of the seat of yellow fever ac- 
cording 1 to M. Tommasini; according- to M. Bailly, according- to M. Francois; 
according- to M. Dubreuil; according to M. Broussais; according- to V. Coste. 
Origin of yellow fever. Of the importation of this disease. Opinion of 
Deveze; of M. Bailly. Opinion of Spanish physicians. Could it be propa- 
gated by an army marching through a country. Experiments proposed with 
a view to determine the mode of propagation of this disease. Places and sea- 
sons of its prevalence. Predisposing and occasional causes. If there is a 
miasm it cannot act except with a concurrence of these causes. History of the 
yellow fever at Port du Passage. Of the yellow fever at Gibraltar. 

Treatment of Yellow Fever. 

Conditions necessary to the avoidance of the disease in the country in which it 
prevails. Method of M. Bailly in the treatment of this fever. Mortality of 
this disease greater than that of typhus. How M. Bailly treated himself when 
he was attacked with the yellow fever. Of blood-letting in yellow fever. 
Method of M. Jourdan. Opinion of M. Jourdan. Opinion of M. Dupuytren. 

Page 314— 348 

CHAPTER IX. 
OF THE PLAGUE. 

Idea vulgarly attached to this word by many physicians of the present day. His- 
tory of the plague of Nimeguen, described by Diemerbroeck. History of 
the plague of Marseilles, described by Bertrand. Results of autopsy. Histo- 
ry of the plague of Russia, described by Samoilowitz. Results of autopsy. 
History of the plague of Egypt, described by M. Desgenettes. Results of au- 
topsy. History of the plague of Noja, described by Vitangelo Morea. Re- 
sults of autopsy. History of the plague of the Morea, by Bobillier. Nature 
and seat of the plague. Occult proximate cause of the plague. Whether the 
plague originated in Egypt. 

Treatment of the Plague. 

Prophylactic measures. Idea which has long influenced the treatment of the 
plague. Method of Bertrand. His opinion on blood-letting. Opinion of M. 



CONTENTS. XI 

Desgenettes with regard to this operation. Local treatment of the plague, ac- 
cording to M. Larrey. Of friction with ice, recommended by Samo'ilowitz. 
Of friction with oil of olives. Profound views of Cullen. Precept of Die- 
merbroeck. Page 349-568 

CHAPTER X. 

OF QUARANTINE. 

Of contagious diseases. Of importable diseases. Is all the good effected by 
quarantine which is ascribed to it? Answer with regard to plague, with re- 
gard to yellow fever, leprosy. Cholera morbus. Analysis of the instructions 
according tc which quarantine is prescribed. Vagueness of this instruction. 
Of patents. Of fumigations. Consequences of the quarantine regulations. 
How ships should be distinguished on their arrival in port. Necessity of a re- 
form in the system of quarantine. Quarantine illusory in most cases. 

Page 369—381 

CHAPTER XI. 

OF INTERMITTENT FEVER, AND PARTICULARLY OF BENIGN 
INTERMITTENT FEVER. 

Pinel has rendered an important service to medicine, in classing each intermittent 
fever W'*" 1 . the continued fever whose symptoms it presents. Description of 
simple intermittent fever, according to Boerhaave and Stoll, or of intermittent 
fever in general. Different types of intermittent fever. Of the character of 
the paroxysms, according to the type. Of the apyrexia. Conversion of in- 
termittents into each other. Termination. Division of these fevers, accord- 
ing to the season; according to then' severity. Division according to their 
symptoms, according to Pinel. Description of inflammatory intermittent fe- 
ver; of gastric, of mucous, of adynamic, and of ataxic intermittents. Opinion 
of ML Broussais on the nature and seat of intermittents. Modification of this 
opinion by the author. Nature of intermittents. Influence of marsh miasmata. 
Whether the type of intermittents prove that they differ from continued fever. 
Hypothesis of Willis, of Deleboe, Borelli, Boerhaave, Stoll, Selle, and J. P. 
Frank. Opinion of Reil. Opinion of M. Roche. Reflections on this subject. 
The periodicity of fevers does not prove that they have their seats in the ner- 
vous system. Nature of intermittents, according to M. Guerin de Mamers. 
Their periodicity does not prove that they do not depend on inflammation. 

Treatment of Intermittent Fevers, and especially of Benign Intermittent Fever. 

Should we attempt the cure of them? Reasons for curing intermittents as quick- 
ly as possible. To what must we attribute the frequent unhappy consequences 
of the treatment? The first thing to be done is to change the circumstances 
of the patient. The morbid predisposition of the viscera should be cautiously 
considered. Method of the ancients. What means have taken the place of 
those employed by them. Conflicting opinions of Torti and Rammazzini with 
regard to bark. Why this remedy is preferred to all others, in the cure of in- 
termittents. Treatment of simple intermittent, according to Frank. He has 



Xll CONTENTS. 

observed well, but explained badly. Treatment in the paroxysm, according to 
Stoll. Of inflammatory intermittents, according- to Stoll and others; according 
to Cullen: M. Broussais employs venesection and leeches. Advantages of this 
method, according to M. Duplan, If. Gassand, M. Gaste; according to the au- 
thor. Treatment of gastric intermittents, according to Pinel. What the treat- 
ment should be at the present day. Treatment of mucous intermittents; of 
adynamic intermittents. Of arsenical preparations. Of bitters. Of the al- 
kaloids of bark. Is the action of bark specific? How it cures intermittents. 
First fact; second fact; third fact Inference from these facts. How the exci- 
tation of the stomach, by the bark, prevents the development of intermittent 
fever. Of regimen in intermittent fever. Of the antiphlogistic means in the 
apyrexia. The irritation is not always intermittent. Of ligatures applied to 
the limbs in these fevers. Of blood-letting in the cold stage. Page 382—423 



CHAPTER XII. 

OF PERNICIOUS INTERMITTENT FEVERS. 

By what signs do we discover that intermittent fevers have assumed the perni- 
cious character? Of the varieties of pernicious fever; of the cardialgic perni- 
cious fever, atra-bilious, the choleric, the colic, the cephalalgic, the apoplectic, 
the delirious, the convulsive, the epileptic, the hydrophobic, aphonic, paraly- 
tic, amaurotic, peripneumonic, the pleuritic, dyspnaeic, asthmatic, catarrhal, 
syncopal, carditic, uterine, nephritic, cystic, rheumatic, arthritic, algid, dia- 
phoretic, exanthematic, petechial, icteric. Ordinary type of pernicious inter- 
mittent fevers. Of the nature and seat of pernicious intermittents in general. 
Results of autopsic examination. How pernicious intermittents differ from be- 
nign. Opinion of F. Hoffman on the seat of intermittents; opinion of ML 
Alard; opinion of M. Bailly. 

Treatment of Pernicious Intermittents. 

They should never be left to their natural course. Course to be pursued when 
a benign intermittent begins to assume the pernicious character. When the 
apyrexia is complete. When the paroxysm is renewed. When the physician 
is called during a very short apyrexia. When the paroxysms are sub-intrant. 
When the paroxysms return after the administration of the bark. When the 
paroxysms return, but are of a more feeble character. When they do not re- 
turn. Mode of aclministering bark in pernicious intermittents. When the fe- 
ver is double tertian. Whether we can limit the bark to a small dose. What 
must be done when the irritation of the stomach is manifest. When degluti- 
tion is impossible. When called during the course of a paroxysm. When 
the symptoms indicate a violent irritation. Are there other indications to be 
fulfilled besides the administration of bark in pernicious intermittent fevers? 
Cold baths employed by Giannini. Every cause of irritation should be re- 
moved during the administration of the bark. What must be done when the 
bark decidedly exasperates the paroxysms. When the fever becomes conti- 
nued. Dangers of the bark, pointed out by MM. Alibert and Broussais. Im- 
portant distinction made by M. Broussais of two kinds of intermittent fevers. 



CONTENTS. Xlll 

Action of bark in benign, or pernicious intermittent fevers. Compared to the 
action of this medicine in continued fevers. Action of bark in sub-intrant fe- 
vers. General idea of the action of bark in intermittent fevers. Doctrine of 
M. Tommasini on the Treatment of intermittent fevers. - Page 424 — 460 



CHAPTER XIII. 

OF ERRATIC, ANOMALOUS, PARTIAL, AND MASKED INTERMIT- 

TENTS. 

Of erratic intermittents, anomalous, partial. Of periodical diseases without fe- 
ver. Of masked fevers. Analogy of masked fevers to intermittent fevers. 
All periodical diseases, with or without fever, have not their causes in the ab- 
domen. Medicus liimself furnishes proof against his own opinion. 

Page 461—464 

CHAPTER XIV. 

OF REMITTENT FEVERS. 

Definition. Doctrine of Stoll with regard to remittent fever. Critique of this 
doctrine, by Pinel. Doctrine of Baumes on remittent fever. Symptoms be- 
fore the paroxysm, in the paroxysm, after the paroxysm. Characters of per- 
nicious remittent fever. Of the remission. Three sorts of remittent fever, 
according- to Baumes. Conclusion of the author. What remittent fevers are. 
Causes of these fevers. Opinion of Alexander, of Giannini, and of Ramel, 
with regard to the non-existence of miasmata — of Baumes — of the author. Re- 
sults of autopsic examination, according to M. R. Thomas, according to Baumes. 
Conclusion. Type of remittent fevers. Inflammatory remittent fevers, bilious, 
mucous, adynamic, ataxic. Nature and seat of remittent fevers. Prognosis. 
Treatment of remittent fevers. Method of Pinel. Treatment of benign re- 
mittents, according to the author: during the remission, during the paroxysm. 
Treatment of pernicious fevers, according to the author. Objections to the 
method of Torti. The existence of remittent fevers proves the analogy of the 
nature and seat of continued and intermittent fevers. - - Page 465 — 477 

CHAPTER XV. 

OF CHRONIC FEVERS. 

How continued or intermittent acute fevers pass into the chronic state. Of the 
hectic fever, according to M. Broussais; of gastric hectic; pectoral hectic; ge- 
nital hectic; hemorrhagic hectic; cutaneous hectic; moral hectic. Hectic fe- 
ver is not always a gastro-enteritis. Causes of hectic fever. Termination of 
hectic fever. Of the hectic of pain, and the hectic of absorption. Results of 
autopsic examination. 

Treatment of Hectic Fevers. 

Whether bark should be prescribed in continued hectic fever. Whether we 
should endeavour to arrest the colliquative sweat. Distinction of hectic fevers 



XIV CONTENTS. 

into two varieties, the one with, and the other without, gastric irritation. Of 
chronic intermittent fevers. Of Splanchnic intermittent fevers. Results of 
autopsic examination. Inference from these results. The state of the gastro- 
intestinal mucous membrane after these fevers have not been sufficiently insisted 
upon. Chronic intermittent fevers ultimately become gastric, when they have 
not been so from the beginning-. What principles should guide the practitioner 
when he is desirous of preventing obstructions. Treatment of obstructions 
when they are old, when they are recent. What is to be done when the chro- 
nic intermittent fever becomes continued. - Page 478 — 488 

CHAPTER XVI. 

OF SIMPLE AND COMPLICATED FEVERS; OF ESSENTIAL OR PRI- 
" MITTVE FEVERS; OF SYMPTOMATIC OR SECONDARY FEVERS, 
AND OF HUMORAL FEVERS. 

Nature of a simple fever; a complicated fever; an essential fever; a symptoma- 
tic fever; a primitive fever; a secondary fever. Complication of essential fevers. 
Of fevers which supervene in the course of another disease. All fevers are 
essential in one point of view. It is proper to distinguish primitive from se- 
condary fevers. Of exanthematous fevers. Of fevers which accompany or 
precede internal inflammations, hemorrhages, and neurosis. Of traumatic fe- 
vers. All these fevers are not to be referred to gastro-enteritis as their cause. 
Results of these principles. Of humoral fevers. - - Page 489 — £96 

CHAPTER XVII. 

OF FEVER. 

What fever is, according to Galen: important remark of Avicenna and Fernel: 
according to Paracelsus; according to Van Helmont; according to Screta; ac- 
cording to Sydenham; according to Borelli; according to Bellini; according 
to Chirac; according to Stahl; according to F. Hoffman; according to Bordeu; 
according to Brown; according to Pinel. What we should understand at the 
present day by fever. Whether febrile irritation differs from inflammatory ir- 
ritation. Whether the irritation which constitutes intermittent fevers differs 
from inflammation. Treatment of fever, according to Galen and his succes- 
sors. Brown and Pinel have proscribed blood-letting. What remains to be 
done to complete the history of fevers. To perfect the treatment of fevers. 
Fortune of the physiological doctrine. - Page 497 — 504 



INTRODUCTION. 



GENERAL PRINCIPLES 



PHYSIOLOGY AtfD PATHOLOGY. 



1. Of Life and Organization. 

1. Life is the mode of existence and action peculiar 
to organized bodies. 

2. Organized bodies are composed of parts, of which 
each acts in a special manner for its own preservation, 
and for that of the whole. The most simple appear to 
consist only of a kind of cellular membrane. At the 
head of the most complicated is Man. 



2. Of the Huynan Body. 

3. Man presents to the immediate action of the bo- 
dies which surround him, or which penetrate into his ca- 
vities, only an excitable absorbent and exhalent tissue. 

4. The external portion of this tissue is in contact 
with the air and light, caloric, electricity — substances 

2 



10 :n:f. :i i:i::m 

diss eriiii ted thitizh the 2:11:57 be re — ini 
:.:: ."".lis. :ii ::::•:: ':'::: : : 5 5 e 5 I: iiireheidi 
the skin, the conjunctiva, the membrane which in- 
vests the external auditory canal and the tympanum, 
the naso-buccal mucous membrane, and that which covers 
: 1 e : irii.5 : : 1 e 1 11 1 : 1 . 

5. The inni 1 1:11 :: this 1551 : :i: neh ei is :he 
:::-'::::::'i'i;:::5iti:: 111 receives the 

impression of die air, of die imponderable agents of sub- 
511:1 zz'izz'.ti " ::h :':.- iiiihn: the ::::yi::-:i- 
testiiii 1 :;: : is ne: 111:1 5iie::ed 1: :he 1111 ;: : 
nediiiei :ii 1 : 1.5:1.5. hi 115-5 :ver it 111 ihiih i; 
1111:11:15:1:.: lie iinhii. ei: 1 :r :i nn: 

lie m : : 15 iei': nie :: the 11: 111 

iv, the 1.1:1' 11... ' .e ::' :ie 

d. These i"": 1:11:15 : :' 111 "ii:: thru lie sir- 
ihee 1 lie 1:1 ire 1:111.1 :ie ~::i the ether: 
iinates, the other comn e 11 Their 
structure is not every where the same, hut it does not 
vii" 511:1117 :i tie diieiei: 1111 the:: 1111: :: 
cast any doubt upon their analc 1 

7. B esiies the 11111.5 11111 :i:i :i 11:15 
which are better entitled to the name of internal, since 
they are never in contact with external agents in a state 
of health: these are the serous and synovial membranes; 
thin and diaphanous in structure, and intimately related 
in action to the mucous membranes, and still more so to 
die skin, the functions of which they partly suppi 

8. In the interstices of all these membranes are found 
canals, which carry the chyle, the lymph, the black and 
red blood, called the chyliferous and the lymphatic ves- 
sels, and the blood-vessels, comprehending the veins and 
1: ten. 

9. In connexion with the blood-vessels are found, the 



INTRODUCTION. 11 

heart, which receives from the body the black blood, 
and sends out to it the red blood ; and the lungs which 
receive the black blood from the heart and send to it 
the red. At the extremity of the arteries are the secre- 
tory organs, such as the cutaneous cryptai, the mucous 
follicles, and the glands, — organs which open on the sur- 
face of the mucous membranes or the skin, by canals 
carrying liquids, of which some are destined for assimi- 
lation and generation, and others are to be eliminated 
from the animal economy. The thymus gland, the cap- 
sular renales, and the spleen are also situated along the 
course of the blood-vessels, although their functions are 
not exactly understood. 

10. Along the course of the lymphatic vessels are 
found the glands of the same name, the use of which is 
unknown, whatever may be the opinion of most physio- 
logists on this subject. In like manner we find along the 
course of the chyliferous vessels the mesenteric glands, 
the use of which are equally unknown. 

11. At the centre of the human body are found the 
cerebro-spinal and ganglionic nervous systems, which 
communicate with each other and with the heart, the 
lungs, the skin, the mucous membrane, the secretory 
organs, the vascular glands and the vessels, and establish 
a communication among all these parts. 

12. On the confines of the skin and the mucous mem- 
branes and at the peripheral extremities of the nerves, 
are found the organs of sense and those of locomotion, 
all of which are intimately connected with the cerebro- 
spinal system by the nerves, and with the heart by the 
vessels. We may regard the organs of sense as possess- 
ing an affinity with the mucous membranes, since they 
also have relations with the surrounding bodies and equal- 
ly transmit impressions to the nervous centres. 



12 INTRODUCTION. 

14. The soft permeable mass, traversed in every di- 
rection by delicate vessels situated between the skin, the 
mucous, and the serous membranes, in the interstices of 
the viscera, and the muscles, and entering as an integral 
part into the membranes, the viscera, the muscles and 
the bones themselves, has received the name of cellular 
tissue. 

15. The human body is then formed of diverse parts 
called organs, connected by vessels and nerves, and com- 
municating with external bodies through the interme- 
diacy of a membrane likewise formed of very important 
organs continuous with one another. 

16. The organs derive their nourishment from appro- 
priating to themselves the red blood which is prepared 
by the pharyngo-intestinal mucous membrane, the chy- 
liferous vessels, and the lungs, and which is conveyed 
to them by the arteries. 

17. The red blood, and perhaps the black, furnish the 
materials from which the organs elaborate all the fluids 
except the chyle. 



3. Of Organic Action. 

18. The ancients, in comparing life to a circle, gave 
a sufficiently just idea of organic action, since there is 
neither any known point of departure nor any complete 
interruption. 

19. Organs, possessing from their connexion, a reci- 
procity of action, and penetrated by blood, upon which 
they act, and which serves for their maintenance ; air, 
caloric, light, electricity, food and drink, sexual and 
solid relations, and the known conditions of the exist- 
ence and reproduction of the human species. 



INTRODUCTION. 13 

20. The solids are the first to feel the influence of sur- 
rounding bodies, which they transmit to each other, and 
to the blood and fluids which they contain. 

21. Organic tissues are not all equally exposed to the 
impression of external agents: this action is first sus- 
tained by some point of the surface and only intermedi- 
ately by the rest of the economy. 

22. The air by the diverse modifications which it un- 
dergoes, acts upon the skin, the conjunctiva, the mem- 
brane which externally covers the tympanum ; upon the 
naso-buccal mucous membrane, and the teeth, and final- 
ly, upon the membrane which covers the larynx, the 
trachea, the bronchia, and their ultimate ramifications. 
Its influence is first felt by the vessels and nerves which 
cover these different parts. It powerfully modifies the 
lungs and the blood, and, consequently, the rest of the 
economy. The ancients regarded it as the aliment of 
life. We are but little informed with regard to its di- 
rect influence upon the pharyngo-intestinal mucous mem- 
brane. Set in motion by the vibrations of sonorous bo- 
dies, it acts through the intermediacy of the tympanum, 
upon the ramifications of the acoustic nerve. Charged 
with odoriferous particles, it operates upon the olfactory 
nerves spread upon the pituitary membrane. Light acts 
upon the skin, penetrates into the eye, and having un- 
dergone various refractions, falls upon the retina. The 
other imponderable agents act in the first place, only on 
the surface of the body, and have but a secondary ac- 
tion upon the internal parts. 

23. Alimentary substances act not only upon the lips, 
the tongue, the teeth, the gums, and the membrane of 
the mouth, but also upon that of the pharynx and oeso- 
phagus; having reached the stomach, they there under- 



14 INTRODUCTION. 

go important changes in consequence of their action upon 
the lining membrane of this viscus ; they then enter the 
duodenum, whence they pass into the other intestines, 
losing at each instant some of their principles and reco- 
vering others, until finally their debris arrives at the 
rectum and is expelled. During this passage, a powerful 
action is exercised upon the whole extent of the pha- 
ryngo-intestinal membrane, all the nerves and vessels of 
which are successively brought into play. 

24. All the modifiers of the organism act then, in the 
first place, only upon a point of the external or internal 
surface of the body. 

25. If the impression of these agents is feeble, or, if 
the tissue upon which they act, possesses but little exci- 
tability, it is confined to the tissue which receives it, and 
produces a modification purely local, often inapprecia- 
ble in its results, and imperceptible even to the indivi- 
dual. 

26. If, on the contrary, this impression is strong, or, 
if the tissue is very excitable, its influence is felt more 
or less remotely, extending from organ to organ, in such 
a manner that all are called into play by the action of a 
single one. 

27. The action and reaction of organs constitute what 
is called the functions. 

28. Functions are executed by perceptible movements 
in the living tissues, and probably by movements in their 
molecules. The latter movements are designated by the 
name of living chemistry, a denomination altogether im- 
proper, and that of molecular organic action, a prefera- 
ble appellation, since it supposes nothing but the action 
itself, which cannot be contested. 

29. The investigation of the essential cause of orga- 
nic action, of the vital principle, is destitute of utility, 



INTRODUCTION. 15 

and may in practice prove prejudicial : it is the philo- 
sopher's stone of physiology. 



4. Of Excitability. 

30. A property, common to all living bodies, is exci- 
tability, which may be defined the aptitude of an orga- 
nic body to enter into action, in consequence of impres- 
sions exercised upon it, or which the parts composing it 
exercise upon one another. 

31. If all the parts of living bodies had the same struc- 
ture and the same action, excitability would be every 
where the same; — this is probably the casein beings, 
who appear to be formed of a single tissue ; but since in 
every living body, composed of several organs, the tex- 
ture and the action, although analogous, are different in 
the different parts, excitability must likewise differ. 

32. Does this property vary only in degree, in each 
organ, considered in an isolated manner? 

33. Does this property differ only in degree in the 
different organs compared with each other? 

34. If excitability varies in any other manner than in 
degree in each organ, there must be as many species of 
excitability, as there are organic modifications, and con- 
sequently there would be no excitability in the sense 
which we attach to this word. If excitability varied 
otherwise than in degree, in the different organs, com- 
pared with one another, each organ would be a being, 
having, in rigorous language, a proper life, in one word, 
an animal ; and the reproach which has been cast upon 
Bordeu, would be unfounded. If this celebrated phy- 
sician has seen, that vital action varies in the different 
organs, no one has proved better than he to what point 



:~ 




3dfy 9 Win tike cxditoMEbty of tin 




INTRODUCTION. 17 

has no existence, when the retina becomes insensible in 
part of its extent. — If, on the contrary, the excitability 
of this nervous expansion be exalted, the luminous rays 
which ordinarily are not visible, appear distinctly, and 
we then perceive the red, the violet, and other rays, 
which are not seen in the ordinary state of the eye. 
Hearing is lost when the Eustachian tube is obliterated, 
when the auditory nerve has lost its excitability, or when 
its communication with the brain is interrupted. We 
continue to hear sounds after they have ceased, when 
they have struck the ear for a long time, violently, or 
under circumstances that have greatly exalted the cere- 
bral excitability. A ball held between two fingers, 
which are crossed, gives the sensation of two balls. A 
body, whose temperature is considerably elevated, ap- 
pears cold, when applied to an inflamed part of the skin. 
It is in consequence of an excess of excitability in the 
olfactory nerves, that we must attribute the pleasure 
which pregnant or hysterical women derive from in- 
haling fetid odours, and the aversion they manifest for 
agreeable ones. It is owing to great irritability of the 
nerves of taste that chlorotic girls and pregnant women 
relish substances which appear totally devoid of taste. 
Finally, the genital organs, fatigued by frequent excesses, 
sometimes experience agreeable sensations from the ap- 
plication of stimulants, which, under other circum- 
stances, would be productive of pain. 

38. On a first view, nothing would appear more re- 
motely separated than pleasure and pain, yet, pleasure, 
when it is carried to a certain point, becomes painful; 
and, on the other hand, there are pains which are not 
devoid of pleasure; this remark has been justly made by 
Plato : the fact is entirely referrible to the agreeable or 

3 






18 INTRODUCTION. 

painful perception which pertains to diverse degrees of 
organic sur-excitation. 

39. If we examine the results of nutrition, we shall 
find that it is in fault, either through excess or defect. 
when an organ exceeds or falls short of its ordinary vo- 
lume. 

40. If a tissue becomes, either in whole, or in part. 
similar to another, it is owing most frequently to an ex- 
altation, though sometimes to a diminution, of its nutri- 
tive action. Thus, we find it assuming the aspect of a 
tissue, more or less excitable than itself. A broken bone 
becomes soft and cellular at its extremities, by the in- 
flammatory process developed in its fragments, which do 
not become firmly united until after the inflammation 
has ceased. When it extends to the periosteum and the 
adjacent muscles, and persists in these tissues, their ex- 
citability declines, and, owing to the atony which re- 
sults, their ossification takes place.* 

41. It is in consequence of the prolonged exaltation 
or depression of vital action, that is to say, under the in- 
fluence of pain and an afflux of blood, or of insensibilitv 
and slowness of the circulation, or, finally, of an alter- 
nation of these two opposite states of the nutritive ac- 
tion, that accidental tissues, without analogy in the hu- 
man system, develop themselves. 

42. The result of the variations of the nutritive ac- 
tion, is the predominance in the subtraction of one or 
more elements of the diseased organic tissue, or the con- 
veyance to it, of elements which do not belong to it in 
its normal condition : to this source are to be referred 
the perversions of nutrition. 

43. Sympathetic action, being the result of the con- 

* Journal Universal des Science Medicales, tome viii. 



INTRODUCTION. 19 

nexion established between the organs by the nerves and 
the vessels, the nervous action and the circulatory move- 
ment, cannot be perverted : sympathies can only be more 
or less active; the functional connexion which exists be- 
tween two organs can never be perverted, except as it 
becomes too intimate, or the reverse, or as it occurs be- 
tween certain organs of the economy rather than others. 

44. What has been said of the nerves distributed to 
the organs of sense, and the muscles, may be applied to 
the ganglionic system, as far as is possible, at a period 
when so much remains to be investigated with regard to 
the action of the nervous system. 

45. The brain does not appear to be a simple organ, 
it is rather a system of organs: but for a long time to 
come, we shall have to regard it as we have hitherto 
done, as the centre of all the sensations, and the point 
of departure of all the volitions and of many movements. 
Consequently, what has been asserted of movements and 
sensations, is applicable to it. There exists, in like man- 
ner, a higher or lower degree of memory, imagination or 
judgment: these faculties are exalted, diminished, or 
annihilated, in disease. They are said to be pervert- 
ed when the mind remains too long fixed upon a single 
subject, in reminiscences without appreciable cause, 
in hallucinations, in those cases in which the ideas are 
no longer connected, or the judgments do not corres- 
pond with the ideas and impressions, where there are 
desires, inclinations, volitions, and acts repugnant to the 
physical and moral nature of man : in all these cases, 
there is only augmentation or diminution of one or more 
of the affective or intellectual sensorial actions. — These 
phenomena belong to the mysterious subject of volition 
and perception ; but when considered with reference to 
the organ manifesting them, they can be regarded only 



20 INTRODUCTION. 

as the result of an augmentation or diminution of action* 
in the whole organ, in one or more of its parts, or in its 
connexions. We must always bear in mind the part 
which the other organs take in stimulating to action the 
affective and intellectual faculties. 

46. There was a time when specific and spontaneous 
alterations were gratuitously attributed to the humours: 
at the present day. we only know that the blood may 
abound more or less in its red or white parts, be more or 
less capable of exciting the tissues with which it is in 
contact, or of furnishing the materials of nutrition: that 
it may contain various substances, owing to the morbid 
state of its vessels, and receive materials introduced into 
the economy, unaltered by organic action. The conse- 
quences of these diverse states of the blood is scarcely 
known. This is a point worthy of the attention of phy- 
siologists, though of little practical importance, in refe- 
rence to the diagnosis and treatment of maladies. The 
future will decide whether we are censurable in with- 
holding for the present our assent to pure hypothesis; 
should observation establish their truth, we shall not re- 
pent our hesitation to admit them: for humanity gains, 
and science loses nothing by this repugnance to the ad- 
mission of any thing that has not been demonstrated. 

47. Whatever opinion may be adopted with regard to 
the comparative irritability of organs, it still remains 
true, that excitability is only susceptible of augmenta- 
tion or diminution in each of them, since in each organ 
function varies but in degree. 

48. Considered in general, excitability does not ap- 
pear to be susceptible of an absolute increase, as the 
means have never been discovered of prolonging life be- 
yond the ordinary term: nor is it more susceptible of a 
uniform general increase, although organic action some- 



INTRODUCTION. 21 

times appears to be modified in all points of the body as 
it is in a single one. 

49. Excitability decreases in proportion as man ad- 
vances towards the end of his existence. 

50. Organic action undergoes continual variations, but 
as long as the integrity of structure continues, and the im- 
pression of stimulants is moderate, excitability is not so- 
licited beyond the degree necessary for the maintenance 
of life : there is an equilibrium of organic action, exci- 
tation, normal stimulation; the subject experiences the 
feelings of well-being, which characterizes health. 

51. If in consequence of external agents, or owing to 
native or acquired disposition, one or more organs are so 
modified that the excitability is too strongly solicited and 
the organic action is in excess, there is snr- excitation in 
the part which receives the impression of the stimulus : 
this state is denominated excess of tone, of force, sur-ac- 
tion, sthenia, hypersthenia, hyperesthesia, irritation. 

52. If the external impression be so feeble as to be in- 
sufficient for the maintenance of life, the excitability is 
not sufficiently solicited, and the organic action is lan- 
guishing; if this action is depressed or exhausted by too 
frequent or too prolonged an exercise, there is sub- exci- 
tation, sub-action, atony, weakness, asthenia, hyposthe- 
nia, anesthesia, abirritation. 

53. Certain agents, few in number and little known, 
appear not only insufficient for the maintenance of vital 
action, but capable of depressing it, and they may even 
occasion the sudden destruction of life, by producing 
such a modification of the organs as is incompatible with 
their farther action. 

54. What has been said with regard to the effects pro- 
duced by external agents on the organic action, is appli- 
cable to the reciprocal influence exercised by the organs 



22 INTRODUCTION. 

over each other: this influence becomes either too little 
or too great, or the cessation of action in one of the or- 
gans arrests that of all the others. 

55. Sur- excitation and sub- excitation constitute the 
state of crease, ^considered with reference to organic 
action. 



5. Of Organic miction in a State of Health. 

56. Excitability is not solely the result of the impres- 
sion of agents, which are at our disposal, upon the living 
solid, since we cannot, even with the most energetic sti- 
mulants, restore organic action in a dead body. Exter- 
nal stimulants acting upon the skin, the mucous mem- 
branes, the organs of sense, and their nerves, only main- 
tain organic action or excitability, brought into play by 
internal stimulants, that is to say, by the reciprocal in- 
fluence of the organs. 

51. This mutual action of the organs varies in each of 
them, according to the part they perform in the preser- 
vation of the subject. 

58. We must suppose, that of all the organs of the hu- 
man body after birth, the brain, the spinal marrow, the 
heart and the lungs, are those in which this vital action 
displays its greatest activity, since death is the necessary 
and direct consequence of the destruction of one of those 
organs. Next, in order of importance, is the digestive 
canal and its connexions. The low rank assigned to the 
chylopoietic viscera in the scale of organs, needs occasion 
no surprise, as our present object is to determine what 
organs are most essential to the animal economy, the pri- 
vation or destruction of which would be most rapidly fatal. 

59. If, on the contrary, we are determining the rela- 



INTRODUCTION. 23 

tive importance of the organs with reference to the pre- 
servation of the animal; the digestive canal presents it- 
self firsts and all the other viscera are only its auxilia- 
ries. 

60. The members and certain parts of the organs of 
sense obey an impulse of volition, excited in the brain 
by internal and external impressions, and transmitted to 
the muscles by the nerves, and sometimes a cerebral im- 
pression coming from the interior or the exterior, which 
does not awake the consciousness of the individual, (cse- 
nesthesia:) the infant sucks the breast before he sees it. 
In a profound reverie, the hand is withdrawn from the 
fire without any perception of burning on the part of 
the individual. The digestion is tedious, incomplete, 
and may become painful, when the brain is deeply en- 
gaged in reflection or suffering from grief. 

61. In a state of health it is seldom possible that two 
organs can be excited to the same degree, unless in con- 
sequence of the action of a single stimulant, operating 
directly upon one and sympathetically on the other. 
When several organs are excited at the same time by 
stimulants, appropriate to each of them, they react pow- 
erfully upon each other, and the excitation becomes as 
general as it is possible. This occurs in a state of health, 
when to the excitement produced by good cheer, is add- 
ed that derived from venerial excitement. 

62. Besides the degree of excitability which belongs 
to each organ, on account of the part it performs in the 
animal economy, the vital action predominates in certain 
organs, according to the age, the sex, and the constitu- 
tion. 

63. In infancy, the predominance of activity is re- 
marked in the digestive and respiratory organs, in the 
encephalon, or in several of these parts : this predomi- 



24 INTRODUCTION. 

nance gives rise to four classes of infants, of which the 
first are disposed to irritation of the stomach and intes- 
tines,- the second, to that of the bronchia; the third, 
to encephalic irritations, and the fourth, to gastric or 
bronchial, complicated with cerebral irritation. 

64. At the epoch of puberty, the predominance of 
vitality displays itself principally in the chest, and the 
vocal and genital organs. This sur-activity predisposes 
to phlegmasia of the lungs, the larynx, to venerial ex- 
cess, and its dangerous consequences. 

65. In women at the age of puberty, it is generally 
the uterus which possesses this excess of vital action. 
Hence arise the acute diseases of this organ, and the 
foundation is thus slowly laid of those chronic maladies 
which frequently do not fully display themselves, until 
after the organ has become unfit for generation. If the 
chest in women be frequently the seat of disease, this ge- 
nerally arises from the influence of the genital organs. 

66. In men who have passed the period of adolescence, 
this organic predominance exists in the lungs, and ma- 
nifests itself in any other organ, either in consequence 
of native disposition, or of the numerous agents to the 
influence of which they are subjected 

67. The predominance of vital action in an organ, 
which exercises a certain influence over the rest of the 
organism, constitutes what is generally called tempera- 
ment. 

68. The doctrine of temperaments, generally adopted, 
is based upon an erroneous manner of contemplating the 
living body as a whole. At a period when all diseases 
were attributed to the blood, the bile, the lymph, and 
the atrabile, Galen was of opinion that each of these hu- 
mours predominated in certain subjects, and sought in 
the different parts of the body, and even in the colour 



INTRODUCTION. 25 

of the hair, for signs of their predominance. But the 
downfall of this theory was complete, when Cabanis and 
Halle, pursuing the path which Bordeu first struck out, 
assigned the organic character of predominance of ac- 
tion, in the lungs, the liver, the brain, the lymphatic 
system, and the muscles, and thus established a better 
theory of the sanguine, bilious, atrabilious, athletic and 
lymphatic temperaments of the ancients and moderns. 
We must set out from the principles established by Ca- 
banis and Halle, to complete what they so happily com- 
menced, and to inquire whether they have not overlooked 
the influence of the predominance of certain organs, not 
less important than those which have attracted their at- 
tention.* 

68. The characters, which have been assigned to the 
sanguine, nervous, and lymphatic temperaments, are ar- 
bitrary groups of physiological phenomena, as the gene- 
ral maladies of the partisans of the symptomatic patho- 
logy are only arbitrary groups of pathological phenome- 
na. We must then reject them, and confine ourselves 
to the study, not only of the predominance, but likewise 
of the insufficiency of action in each organ, and the ef- 
fects of these states upon the rest of the economy. I 
am particular in mentioning insufficiency of action, be- 
cause hitherto this condition has been very imperfectly 
studied. Those, who have attended to it, have content- 
ed themselves with saying, that the weakest organs are 
those most exposed to disease, a proposition contradict- 
ed by observation. f 

* Principes generaux de Physiologie Pathologique, seconde edition, Paris, 
1828, 2 vols, in 8vo. 

f Voyez mon article sur Vasthenie, dans le Dictionnaire abrege de Sci- 
ences Medicales, 1820; les Nouveaux Elemens de Pathologie medico-chirur- 
gicale, de MM. Roche et Sanson, Paris, 1828, 2d edition, 5 vols, in 8vo; le 
Traite de Thcrapeutique de M. Begin, Paris, 1825, 2 vols, in 8vo; et le Me- 

4 









26 INTRODUCTION. 

69. Predominance of action in a particular organ ren- 
ders it liable to receive the impression of morbific causes ; 
this predominance predisposes to disease : it is never ge- 
neral : it is then conformable to facts to say, that the 
morbific disposition always resides at first in some parti- 
cular organ, and that it does not display itself in several, 
until it has fixed itself strongly in a single one. 

70. As excitability varies every instant in each organ, 
it is no less true, that men, compared with each other, 
(organ for organ, and not in their muscular and osseous 
tissues alone, as is frequently done.) present notable dif- 
ferences of excitability, and that some are more or less 
excitable than others : this constitutes idiosyncrasy. 

71. These differences are observed to characterize 
whole nations, classes, and professions, as well as indivi- 
duals, but they cannot be subjected to a rigorous calcu- 
lation : like life, they are possessed of mobility: they de- 
pend upon the circumstances which act upon individuals, 
or upon bodies of men united in classes and nations. 
There are, in a certain sense, national idiosyncrasies. 
This is what is called the physical and moral character 
of each people. 



6. Of Organic Action in the State of Disease. 

72. Whenever an organ is injured, there is disease; 
every disease is the lesion of one or more organs; in 
every malady, there is a modification of organic action : 
we cannot conceive of this modification of action with- 
out a modification of the organ itself. 

73. Organic alterations are not visible when the or- 

moire de M. Vacquie rar Vastkenit, couronne par le Societe Medicate d'erau- 
Iation in 1S30. 



INTRODUCTION. 27 

gan is deeply seated, or is covered by another, when they 
occur in the centre of an organ, or in its most delicate 
parts, for we are unacquainted with the intimate struc- 
ture of the tissues. There are sometimes also alterations 
of function. 

74. Alterations of function are always connected with 
alterations of structure. When the latter are not appa- 
rent, we conjecture their nature from the character of 
the former. 

75. There are, consequently, in the state of disease, 
organic modifications which are concealed, and others 
which are manifest, (sympto?ns,) and it is from the latter 
that we judge of the former. 

76. Often, after a most careful examination, the only 
symptoms we can discover are lesions of function, and 
in such cases it is frequently thought that the disease is 
one which affects the entire organism, and falls upon no 
organ in particular. 

77. The different natural or artificial groups of symp- 
toms, have received the name of disease. The ancients, 
to designate a group of symptoms, made use of a word, 
which it will be useful to revive, viz : syndrome. This 
denomination will be more proper than that of prodrome > 
which has synonyms in the French language. The de- 
signation of metadrome might be assigned to the organic 
changes discovered after death. A multiplicity of pari- 
phrases would thus be avoided. 

78. Since it is impossible to trace back disease to de- 
rangement of the molecular action of the diseased organs, 
we must, as frequently as possible, discover its causes in 
the sensible alteration of their structure. Since symp- 
toms depend on altered structure, we can only cause their 
cessation by remedying the organic alteration, which has 
produced them. We must not, then, suffer ourselves to 



28 INTRODUCTION. 

be arrested by the contemplation of symptoms, but we 
must go back, whenever it is possible, to the nature and 
seat of the disease, that is to say, of the appreciable or- 
ganic alteration. 

79. To know the seat of a disease, is to know the or- 
gans whose lesion gives rise to the symptoms which cha- 
racterize it; to know its nature, is to know in what con- 
sists the organic alteration which constitutes it. The 
internal causes which are sensible, and whose existence 
is proved by autopsy, can alone be the object of medi- 
cine ; we should, therefore, in investigating the external 
and sensible effects and accidents of maladies, endeavour 
to arrive at a knowledge of their internal causes: the 
only means consists in the observation of the state of the 
principal viscera of those who die of every description 
of disease; these viscera are the internal organs of the 
three cavities of the body. 

80. The nature and seat of this alteration are often 
very different from what the symptoms superficially ex- 
amined, would seem to announce. It is not always easy 
to determine the seat of disease during life ; unequivocal 
traces of its existence are often discovered after death; 
but sometimes they disappear completely at the moment 
of the cessation of organic action. 

81. All errors in pathology are derived from the four 
following sources: 

1st, The attention has been given for too long a time 
to the study of symptoms alone. 

2dly, Symptoms have been considered as always 
giving a faithful representation of the state of the parts, 
which, during life, cannot be inspected. 

3dly, We have hitherto neglected to determine the 
organs, upon which each morbific and therapeutic agent 
primarily exerts its influence, and the laws which go- 



INTRODUCTION. 29 

vern the propagation of this influence from one organ to 
another, or to several. 

4thly, It has been thought that these agents should act 
upon the whole organism, at the same time, as they are 
observed to act upon a single one. 

5thly, Finally, many among them have been thought 
to act upon the whole organism at once, because the 
whole organism appears to be affected in consequence of 
their action. 

82. The union of anatomy, physiology, pathological 
anatomy, pathology, and therapeutics, which have been 
too long separated, will, it is hoped, correct these er- 
rors. The union of these different parts of the sci- 
ence of man, considered in the structure, action, altera- 
tion, and restoration of his organs, has not yet been ef- 
fected, because this science is still but little advanced ; 
but to deny the utility of what has been done, because 
much still remains to be done, is to expose oneself to the 
just reproach of ignorance or prejudice. 

83. Before prescribing remedial measures, it is pro- 
per, as far as the case and the actual state of the science 
permits, to attend to the following rules: — 

1st, To neglect no means of discovering what organ 
habitually predominated in the subject before the attack, 
what have been the morbific agents which have acted 
upon it, and upon what organ they primarily acted. 

2dly, To trace, by the aid of the information, given 
by the patient and his attendants, the propagation of the 
morbific influence from organ to organ. 

3dly, To refer each symptom to the organ in which it 
manifests itself. 

4thly, By this means to discover all the organs more 
or less affected. 

5thly, To draw a parallel between these data, and the 






30 INTRODUCTION. 

symptoms which manifest themselves in the organs which 
we know to be predominant in men in general, and in 
the patient in particular. 

6thly, Not to permit ourselves to be led into error by 
the intensity of certain symptoms, which are more pro- 
minent than others; to distinguish those which come di- 
rectly from the organ primitively or most violently in- 
vaded, from those occasioned by the organs secondarily 
or slightly affected. 

7thly, Finally, from a comparative examination of the 
morbific cause, of the individual predisposition, of the 
principal seat of the symptoms, and their nature, to de- 
duce the nature and seat of the disease; that is, of the 
organic alteration which is the principal cause of the 
symptoms. 

84. The nature and seat of this alteration being known 
or presumed, we must choose among therapeutic agents: 
those which are most proper to cause its cessation, or at 
least to diminish its intensity. 

85. All these agents increase or diminish action, pri- 
marily in one organ, and secondarily, in one or more of 
the others. There are none which act upon the whole 
economy at once. It is by inducing salutary modifica- 
tions, at first, in a single organ, and afterwards in seve- 
ral, that they restore the functions to their normal state. 

86. These agents are sometimes applied exclusively 
and directly to the diseased organ, but more frequently 
to some other organ which has a relation of action to it. 
In the latter case, it is almost always to some part of the 
external or internal surface of the body, that we apply 
them, sometimes to the cellular tissue : they are seldom 
introduced directly into the vessels. 

87. Diseases, when abandoned to themselves, are spon- 
taneously cured, when they have but a slight degree of 



INTRODUCTION. 31 

intensity, or when they affect but a small number of or- 
gans. Death is the consequence when they are very in- 
tense, when they invade a great number of organs, or 
even a single organ, the integrity of which is important 
to the maintenance of the action of several others. 

88. A disease becomes more intense in proportion as 
it has been badly treated. In any particular country, 
violent diseases are the more common in proportion as 
the medical doctrines which prevail there are more er- 
roneous. Yet mortality considered in general, is always 
nearly the same, because nature, by an admirable law, 
remedies, in a given time, this, as it does every other 
kind of destruction. The danger and efficacy of medi- 
cine are only important in relation to individuals.* 

89. When the malady terminates favourably, the 
symptoms diminish either gradually or almost suddenly: 
in the latter case, there ordinarily supervene evacua- 
tions, to which a high degree of importance has for a 
long time been attached, designated collectively by the 
name of crises : the happy termination of the disease has 
been attributed to them ; while, in reality, they are only 
the effects, or the signs of this termination. 

90. It has been pretended that crises occur on parti- 
cular days, during which it is necessary to abstain from 
active measures, through the fear of disturbing the sa- 
lutary process of nature; these days, however, have not 
yet been designated with absolute certainty. 

91. At the present day, it would be idle to speak of 
crises, were it not that the theory of the ancients upon 
this point, has induced many physicians to think that 
they should wait for these reputed salutary movements 
of nature, should do nothing through fear of disturbing 
them, and should not even attempt to provoke or to imi- 

* See ray article on mortality, in the Encyclopedic Moderne. 






INTRODUCTION. 

tate them. It is evident that the best means for the pro- 
duction of crises, is to neglect nothing that may dimi- 
nish the intensity of the morbid process, limit its extent 
or direct it. if we may so express it, towards the least 
important organs. 

92. Expectation is not indicated unless we are igno- 
rant of the nature and seat of the disease: when the dis- 
ease is slight: when it is evident that its duration will be 
short, or that it will terminate without treatment: finally, 
when the patient declines submitting to remedial mea- 
sures. 

7. Of Sur- tx citation, or Irritation. 

93. Irritation, that is. the state of an organ in which 
vital action has risen above the degree necessary for the 
maintenance of life, is the most frequent, the most grave, 
and. consequently, the most remarkable of the two pre- 
mature morbid states. 

94. Irritation is never general or uniform in the 
whole organism, because the causes which produc 
always act locally,, and because, in consequence of i 
vidual organic predominance, some particular organ, ac- 
cording to the constitution of the subject, is found to be 
alone affected; or more affected than others, by the pro- 
pagation of this irritating influe: 

95. Irritation is the result of 

1st. An excess of action on the part of e:::t: :.:. irer.:?. 
upon some part of the internal or external surface of the 
body. 

2dly. The propagation of this action to a part func- 
tionally connected with one of the surface s. 

3dly. The temporary abstraction of stimulants from 
an organ, possessed of very exalted excitability : 



INTRODUCTION. 33 

4thly, Or, finally, the debilitation of an important or- 
gan, which gives rise to sur-activity or irritation in an- 
other. 

96. Thus, directly or indirectly, irritation developes 
itself, primarily, in a single organ. Irritation established 
in an organ by any cause, direct or indirect, may exist, 
at least, during a certain time, without revealing any 
symptom of its existence, even when intense and situated 
in an important organ. We discover after death in a 
great number of subjects, profound organic alterations, 
which have no connexion with the disease which termi- 
nated life, and which have given rise to no symptoms — 
alterations perfectly resembling those, the slow forma- 
tion of which is accompanied, in a great number of 
other subjects, with manifest symptoms of irritation. % 

97. Irritation often occasions profound alteration of 
structure, which we recognise during life, when the 
functions are deranged by the progress of these altera- 
tions: otherwise, we do not discover them until after 
death. 

98. An irritation may occasion death without giving 
rise to any characteristic sign of its seat during life, and 
without leaving traces discoverable after death. We 
have then nothing to guide us in determining the seat 
of disease, except the analogy of the morbid phenomena 
observed during life, in these unfrequent cases; to those 
of the more ordinary cases, in which irritation gives rise 
to unequivocal signs of its seat, and leaves corresponding 
traces in the organs. 

99. When irritation manifests itself to our senses, if 
its intensity be slight and the organ visible, we discover 
a redness, scarcely discernible, the heat a little increased, 
or merely a slight excess of sensibility, an unusual ener- 
gy of the function, {sthenic neurosis.) When the or- 

5 



34 INTRODUCTION. 

gan is internally situated, however intense the redness* 
it is not visible: and there is often neither heat nor pain: 
there then remains no other index of irritation than sur- 
activity, or even languor of function, either of that or- 
gan itself or of some other. 

100. This sur-activity must not be confounded with a 
native or habitual excess of energy in an organ, strongly 
developed, either prematurely, or under the influence 
of a lively habitual stimulation. This excess of energy 
may continue a long time without constituting the state 
of disease, (hypertrophy.) 

101. The second degree of irritation is announced by 
pain. a more decided redness, often by an exaltation, 
sometimes by a diminution of the most apparent func- 
tion of the diseased organ. This degree is often misun- 
derstood, or if the effects are observed, the nature and 
seat are mistaken. 

10.2-. Redness well developed, a lively heat, intense 
pain, swelling, the suspension of secretion and excretion, 
and the increase of absorption, characterize a more ele- 
vated degree of irritation, which diminishes gradually, 
{resolution,) or determines one of the following results: 

The re-establishment, sometimes in a sudden manner, 
of the exhalations, the secretions, or excretions, {criti- 
cal evacuations.) 

A morbid sanguineous, serous, mucous, or purulent 
secretion, {hemorrhagy, serous effusion, mucous flux, 
suppuration.) 

A sort of disintegration of the organic molecules, 
sometimes with spontaneous solution of continuity, (ra- 
rnollissement or softening, ulceration, perforation.) 

The sudden extinction of organic action and the death 
of the part, {gangrene.) 

Finally, a transition to the chronic state, whence re- 



INTRODUCTION. 35 

suits a transformation or a degeneration of the irritated 
tissues, (analogous or heterologous accidental tissues.) 

103. Such are the effects of the principal shades of irri- 
tation, that is to say, the phenomena which we observe in 
an organ subjected to a slight or very violent or prolonged 
action of the morbific causes which result in the local exal- 
tation of vital action. If it were necessary to designate 
all the shades of irritation, they would be as numerous 
as the organs of the body, and the different diseases to 
which they are liable. Those which we have pointed out 
may serve as terms of comparison : like all others, they are 
only degrees of intensity, or duration of the same mor- 
bid state, which produces consequences more or less con- 
spicuous, and alters more or less the part in which it ex- 
ists, according to its extent, its profundity, the number 
of tissues it affects, and the length of time it has conti- 
nued. The signs of the highest and of the lowest grade 
are the same; varying only in intensity, in the diverse phe- 
nomena which depend on the organic structure, and in 
the modification which they determine in the organs. 

104. It has hitherto been customary to give the name 
of inflammation to the state of a part which is red, hot, 
painful and swelled ; the use of this term may be conti- 
nued, provided it be understood that it designate, not a 
morbid state, sui generis, but a certain degree of irrita- 
tion, with an afflux of blood, more considerable than is 
necessary for the accomplishment of the nutrition and 
the functions of the organ; sufficiently intense and fixed 
to menace its integrity ; finally, characterized by heat, 
redness, swelling and pain, or by one or more of these 
symptoms, according to its intensity, and the part it oc- 
cupies. 

105. To designate by the term nervous irritation, that 
of the nervous filaments, which are supposed to accom- 



36 INTRODUCTION. 

pany the ultimate vascular ramifications ; to give the name 
of inflammation to the irritation of the sanguine capil- 
lars vessels; of sub-inflammation to the irritation of the 
exhalents and absorbents, is to place the seat of disease in 
parts of which our senses can take little cognizance. This 
is to fall back into an hypothesis, unwarrantable in theory, 
and pernicious in practice: to establish subtle distinc- 
tions, which sound logic rejects, because pathological 
anatomy disavows them. There are no signs in the ac- 
tual state of science, by which we can determine that 
irritation has not extended beyond the nervous filaments, 
or that it is confined to the sanguine or lymphatic capil- 
laries. As no one has seen the absorbent and exhalent 
capillaries, no one can know when their irritation exists. 
Finally, since every malady is an organic lesion* this 
denomination should not be reserved to designate altera- 
tions of texture. Xeurosis. inflammation, sub-inflam- 
mation, hemorrhagy, are words which represent, not 
diseases, but groups of symptoms, the effect of irritation, 
or shades of irritation. These symptoms vary infinitely 
in their number, their intensity, and their succession: 
so that the same organ often presents, in succession, 
signs of neurosis, of inflammation, of hemorrhagy. and 
again those of inflammation, until all these morbid phe- 
nomena cease, while frequently the irritation still persists. 

106. The only nervous irritations are those of distinct 
nerves, of the spinal marrow and brain, and of the ner- 
vous ganglions, and the only vascular irritations are those 
of the arteries, the veins, and the visible lymphatic and 
chyliferous vessels. 

107. When a thick, melliform matter is abundantly 
secreted on the surface of the cutis vera, when the blood 
is poured out on the surface of a mucous membrane, we 
must be content to say. that these parts are sur-excited, 



INTRODUCTION. 37 

irritated; that, in consequence of this sur- excitation, 
there is an excess of secretion, abnormal secretion, se- 
er e tory irritation, hemorrhagic irritation of those tis- 
sues. There exists, without doubt, in the first, an or- 
ganic condition different from that of the second: what 
are these conditions? this we are incapable of determin- 
ing; what we are certain of, is, that they are two effects 
of sur- excitation. 

108. The division of irritation into continued, remit- 
tent, and intermittent, is a better founded and more im- 
portant distinction. On the skin, and on the parts of 
the mucous membranes bordering upon it, irritation is ob- 
served to affect these different types, as is demonstrated by 
the facts collected by Cassimer Medicus,* from the most 
attentive observers of every age. Since the phenomena 
of external irritation cease, when this irritation itself 
ceases, and reappear with it, or assume greater inten- 
sity, when it increases, when we observe analogous phe- 
nomena, evidently derived from an irritation of the vis- 
cera, to cease, reappear, or become exasperated, the 
conclusion is most just, that the irritation which produced 
them has ceased, reappeared, or become exasperated. 
Whatever may be the explanation which is given of the 
intermittence of irritation, it is a fact which we must 
believe, even though unable to account for it. Pinel 
has well remarked, that a disease does not change its na- 
ture in changing its type : by this observation he gave a 
considerable impulse to science. 

109. The functions of an irritated organ are sometimes 
exalted and sometimes diminished; and hence, in the case 
of a patient in whom the functions languish, we must not 
hastily conclude that there is primitive weakness or as- 
thenia. 

* Traite des Maladies periodiques sans fievres. Paris, 1770. 



38 INTRODUCTION. 

110. The duration of irritation varies from a single 
instant to several days, months, or years. It is not un- 
common for it to continue during the life of the patient. 
Yet it frequently terminates after the lapse of a certain 
time, which is usually of the same length for each par- 
ticular organ or tissue; at other times, its duration is in- 
definite, whatever may be its seat. In the first case, af- 
ter having gradually risen to the highest degree of in- 
tensity, it diminishes insensibly, the organ resumes the 
free exercise of its functions; the discharge of which it 
has become the seat disappears; or, if it existed before 
the disease, it returns to its ordinary state : if the irri- 
tated tissue is exposed or has been laid open by the knife, 
cicatrization takes place : the irritation in this case is said 
to be acute. 

111. When the irritation becomes chronic, the part 
frequently presents neither redness, heat, nor pain; the 
swelling or the discharge continues, a solution of conti- 
nuity occurs, or accidental tissues slowly develope them- 
selves. 

112. Such is the progress of irritation when confined 
to a single organ. But when it is very intense, or oc- 
cupies an organ intimately connected with the heart, 
with the brain, or the mucous membranes, or even when 
the irritation, though slight, developes itself in a sub- 
ject in whom these viscera are habitually or accidental- 
ly very excitable, the disease extends itself in the orga- 
nism. Several organs suffer, with the organ that has 
felt the first impression of the morbific cause, {sympa- 
thy.) To the local phenomena of which we have just 
spoken, are added in a greater or less number, those in- 
dicating irritation of the heart, the hair, the muscles 
and the mucous membranes, and sometimes those indi- 
cating the astheny of these organs. These sympathetic 



INTRODUCTION. 39 

phenomena sometimes reduce themselves to a simple aug- 
mentation or diminution of the exercise of the functions. 
When they predominate over the local phenomena, re- 
sulting from the organ primarily injured, there is danger 
of mistaking the nature and seat of the disease, unless 
we are able to penetrate the obscurity of the symptoms 
presented by this mixture of force and weakness. When 
the disease is acute, the circulation disturbed, the heat 
of the surface increased or diminished, and there is no 
prominent sign of local lesion, and no mode of determin- 
ing to what class or species of neurosis, inflammation, 
hemorrhage, or organic lesion, to refer it, it is said that 
it is an essential fever : at least such has been the course 
pursued until within a few years. Since the labours of 
M. Broussais, the necessity has been recognised of no 
longer confining our attention, in studying the nature of 
diseases, to the most prominent symptoms; we must en- 
deavour to discover in every disease which appears to be 
general, the local irritation which has given rise to it. 

113. But there is a fundamental truth, to which Brous- 
sais has not called attention; viz. that the acute or chro- 
nic irritation of any tissue or organ, may be succeeded 
by astheny of this tissue, or organ, whether the local or 
sympathetic signs of irritation persist, or cease with it, 
and that the sympathetic phenomena of irritation may 
continue after the irritation itself has disappeared. Thus 
when we observe a mixture of the morbid phenomena of 
strength and weakness, we must not only trace them to 
the primitive irritation, which has produced them, but 
likewise determine whether the irritation persists with 
them, or has ceased; or, finally, whether it is replaced 
by astheny of the organ, in which it was seated, or of 
any other organ. 

This I conceive to be the fundamental principle which 



40 INTRODUCTION. 

should guide the pathologist in the study of irritation 
and its consequences, and the practitioner in the treat- 
ment of disease. 

M. Lallemand has lately given an admirable demon- 
stration of this pathological view.* 



8. Of Sub- ex citation, or Astheny. 

114. Astheny is the state of an organ, in which the 
action is below the degree necessary for the maintenance 
of life. This morbid state, though less frequently pri- 
mitive than irritation, and less capable of producing dis- 
organization, should not be studied less carefully than the 
latter. 

115. General astheny is as rare as local astheny is com- 
mon. The former, however, occurs at the termination of 
many mortal diseases; but then, whether primary or se- 
condary, it is irremediable. In almost all diseases, we 
observe a secondary local astheny. A person suffering 
is ordinarily but little disposed to motion, and even when 
he desires to move, his muscles slowly and incompletely 
obey his will, or, if they are brought into action, they 
determine irregular movements, on account of some mus- 
cles contracting more feebly than others. But this as- 
theny and this muscular spasm are the effect of an ir- 
ritation, whose influence propagates itself to the brain. 

116. The muscles are not the only organs, which ex- 
hibit this apparent weakness. The same diminution of 
function may occur from the affection of any organ, 
which is irritated. Consequently, we may admit, for the 
sake of distinction, an astheny of function, and an asthe- 
ny of nutrition, or of molecular action. The first is 

* Cinquieme Lettre sur l'Encephale, Paris, 1830. 



INTRODUCTION. 41 

generally a symptom of an irritation, and rarely the ef- 
fect of the seeond. 

117. The distinction, which we have just established, 
it is not always easy to make in practice; but, as astheny 
has hitherto been more frequently imagined than studied, 
this distinction will not be without utility. 

118. The astheny of an organ is the effect, 

1st, Of the diminution or of the complete and pro- 
longed abstraction of the stimulants, which act habitually 
upon it. 

2d, Of the diminution of the exciting influence which 
the organs exercise over each other. 

3d, Of the excessive stimulation of an important or- 
gan, the slightest alteration of which is opposed to the 
continuance of action, in its usual degree, in all the 
others : this organ then acts exclusively for the interest 
of its own preservation, if we may express ourselves 
thus; its nutritive action is exalted, although its sympa- 
thetic functions languish. 

119. A slight astheny gives rise to no morbid pheno- 
mena; whatever be its seat, it is always of short dura- 
tion. If frequently repeated, it may give rise to irrita- 
tion of an organ, which sympathizes with the affected 
organ. 

120. Intense astheny is characterized by loss of co- 
lour, flaccidity, and want of heat in the tissue in which 
it occurs, and by a sort of insensibility; the functions 
of the tissue diminish in activity or cease entirely. 

121. When astheny is very marked in character or 
prolonged in duration, it is often observed that a tran- 
sient irritation suddenly replaces it, and immediately 
disappears, determining the complete extinction of vital 
action in the part, (gangrene.) 

122. Primitive astheny cannot determine chronic dis- 

6 



42 INTRODUCTION. 

organization,, except in subjects naturally very irritable, 
in whom the circulatory action is accidentally languid: in 
individuals of this constitution, slight irritation, often 
inappreciable, occurs from time to time, and favours dis- 
organization,, or the slowness of the circulation alone pro- 
duces it. 

123. Asthenv. consecutive to irritation, is a frequent 
cause of disorganization, it is to this we must refer the 
production of accidental tissues, possessing an activity 
inferior to that of the parts in the midst of which they 
are developed. By alternating with irritation, it deter- 
mines the formation of accidental tissues without analo- 
gy in the organism, tissues in which irritation ultimately | 
predominates, and becomes permanent, giving rise to ul- 
ceration. 

124. The stomach itself may fall into asthenv: M. 
ssais gives to gastro-intestinal asthenv. the name of i 

adynamic languor of : e*. 

125. Gastric asthenia should be studied with care, jj 
were it only because of its power of determining gastri- 
tis. Indeed, in this viscus. as in the organs of sense, as- 
thenv. the consequence of a defect of stimulation, is 
promptly followed by an exaltation of sensibility. But 
if the absence of all stimulation continues, the excitabi- 
lity ultimately becomes exhausted: the organ becomes 
insensible, if it be one of those which transmit external 
impressions to the brain: death occurs, if it be the sto- 
mach, either from want of materials, or because the gas- 
tric mucous membrane ceases to communicate to the i 
brain the impressions,, without which the latter organ 
cannot act. These impressions are more immediately 
necessary than the nutritive materials, since the admi- 
nistration of a stimulating drink excites cerebral action 



INTRODUCTION. 43 

more than the most nourishing substances, which are not 
i of a stimulating nature. 

126. It is only astheny of the brain, of the spinal 
marrow, of the heart, the lungs, and the stomach that 
can directly occasion death. 

127. If the astheny of an organ excite irritation in 
it, the former ceases as soon as the latter is established^ 
there is no asthenic irritation any more than there is ir- 
ritative astheny : for, w r e repeat it, astheny of nutrition 
must not be confounded with astheny of function. 

128. It is not more easy to distinguish astheny of the 
nervous filaments from that of the vessels, than it is to 
distinguish their irritation; that of the lymphatic capil- 
laries is not more distinct, for, if paleness and a relaxed 
state of en bon point, seem to announce it; these symp- 
toms appear to be referrible to one of the shades of as- 
theny of the lungs rather than to any other cause. 

129. Astheny of the arteries appears to have little in- 
fluence, if we consider that they are but instruments, 
which are nearly passive, in the circulation. In the 
veins, astheny is better characterized ; it is recognised 
by varices, by violet spots which form under the epi- 
dermis, by the blue tint of the skin; but what occurs on 
the skin, does not always take place in the mucous mem- 
branes, which are frequently in a state diametrically op 1 
posite. 

130. Astheny of the heart produces different effects, 
according as it occurs in the arterial or venous side of 
this organ. — There results syncope, dropsy, or scurvy, 
according as the weakness is chronic or sudden. 

131. It has for a long time been believed that hemor- 
rhagy without manifest signs of irritation, was the effect 
of astheny of the capillary vessels : in this case it is ne- 
cessary that the heart should preserve a force of impul- 



44 INTRODUCTION. 

sion, superior to the force of resistance of the capilla- 
ries. Even here the hemorrhagy does not establish it- 
self, except after the occurrence of a slight irritation, 
which, after having determined the presence of a great- 
er quantity of blood, leaves the part in a state of astheny. 

132. Morbid fluxes in general are never occasioned 
solely by astheny of the capillary vessels, unless it be at 
the instant of death: we, however, often observe the 
sweat to cease on the approach of death, although the 
weakness must then be more considerable than at any 
former period. 

133. We are led to believe, that astheny, like irrita- 
tion, may be intermittent, but many researches remain 
to be made on this important point of doctrine, which 
the reformed theory of intermittent fevers cannot but 
elucidate. 

134. In general, astheny continues but a short time, 
because man has recourse to stimulants of every kind, 
when he experiences its first symptoms, until, finally, 
he suddenly or gradually exhausts his excitability, by a 
stimulation too violent, or too often repeated. 

135. The astheny of an organ renders it more ac- 
cessible to the causes of irritation, as well as all the 
other organs, even when they do not participate in its 
weakness. This fact, worthy of remark, is one of those 
which no one contests ; but we must not from this con- 
clude that the irritation which supervenes in a debili- 
tated organ or subject, is astheny. 

13Q. M. Broussais, struck by the incontestable fre- 
quency of irritation, shows himself too exclusive in con- 
sidering astheny only a consequence of sur-excitation ; 
in an important organ. If he grants that primitive as- ' 
theny contributes to disorganization, he denies that it \ 
occurs in fevers, which prevents his attempting to disco- f 



INTRODUCTION. 45 

ver the cases, in which stimulants may be employed with 
success in these maladies. 



9. Of Organic Action, considered ivith Relation to 
Therapeutics, 

137. Since diseases are only organic irritation, or as- 
theny, always primitively local, never uniformly extend- 
ed over the whole organism, and often co-existing; to 
cure them, it is necessary, after having distinguished the 
irritated and the weakened organs, to stimulate the lat- 
ter, and to debilitate the former, in such a manner, as 
not to exasperate the morbid state of the one, in attempt- 
ing to calm that of the other. Especially, we must not 
indulge the chimerical hope of increasing excitability 
in an absolute manner; we can only regulate organic ac- 
tion, which is exalted in one part and depressed in ano- 
ther. When excitability is positively diminished, no- 
thing can restore it to its primitive state. On this sub- 
ject, the Brunonians have shared to a certain point the 
error of the alchymists; the latter, sought the divine 
arcanum which should prolong life, while the former be- 
lieved they had found in opium, wine and bark, specifics, 
to prevent its extinction before the latest period allowed 
by nature. 

138. When a disease manifests itself by phenomena, 
which extend to several organs, we must endeavour to 
recognise the organ, whose lesion gives rise to that of 
the others, for the purpose of determining whether it be 
proper to debilitate or to strengthen it, to increase or 
diminish its vital activity, with a view to cause the dis- 
appearance of the sympathetic phenomena, whatever 
may be their nature, whether they appear to announce 



46 INTRODUCTION. 

force or weakness in the organs in which they manifest 
themselves. 

139. The first rule in therapeutics is to remove every 
morbific cause still acting, and to prevent the applica- 
tion of others. 

140. Irritation may be combatted by diverse means, 
which are all efficacious, when they are judiciously ap- 
plied, and of which none should be prescribed indiffer- 
ently in all cases of irritation. 

141. To reduce action in an irritated organ, we must, 
in the first place, reduce the number and energy of the 
stimulants, which habitually act upon it, and then dimi- 
nish the sum of the materials which enter into the com- 
position of the organism, always by diet, often by phle- 
botomy, sometimes by arteriotomy. The indications 
afterwards, are, to diminish the quantity of blood which 
traverses this organ, by the abstraction of blood from 
its capillary vessels, or 'from those which are nearest to 
it; 2dly, To place it in contact with substances called 
refrigerant, emollient, or narcotic. 

142. If the organ be so situated that we cannot hope 
to take away blood directly from its capillary vessels, we 
must not neglect to practise this operation on the organ 
which is nearest to it: diet must be insisted upon, and 
frequently venesection must be resorted to. Refrige- 
rants, emollients, and narcotics must be applied to the 
skin, or the mucous membranes. 

143. To these means, which constitute what is pro- 
perly called the anti-irritative method, otherwise deno- 
minated the antiphlogistic, should frequently be added 
the employment of irritants, placed in contact with a 
tissue, more or less remote from the irritated organ. 
These irritants are, first, rubefacients, vesicatories, and 
escharotics, applied to the skin; secondly, emetics and 



INTRODUCTION. 47 

purgatives, fixed and diffusible stimulants, and tonics 
applied to the mucous membranes. These means belong 
to the derivative method, when the organ to which they 
are applied, is not the irritated organ. 

144. There are cases in which the direct application 
of stimulants, tonics, irritants, rubefacients, vesications, 
and even escharotics, causes the cessation of the irrita- 
tion by accelerating, or by preventing the consequences. 
This constitutes the disturbing method, (methode per- 
turbatrice.) In the internal organs, especially, it is al- 
most always dangerous, either in its immediate or its re- 
mote effects. 

145. When irritation is intense, the anti-irritative me- 
thod alone is suitable. 

146. When by this method, the intensity of the irri- 
tation has been diminished, or when it is slight, the de« 
rivative method is often very advantageous : but if we 
mistake the degree of irritation, if the principal organs 
are very excitable, and particularly the heart, the brain, 
or the mucous membranes; if we produce an action 
which is too violent, or too near the diseased organ, the 
irritation increases in place of diminishing; or instead of 
a single irritation, we often have a second, sometimes 
more serious than the first. 

147. If we consider how high a degree of excitabili- 
ty is possessed by the mucous membranes, the facility 
and promptitude with which their irritation disturbs the 
organism, and occasions the disorganization of their tis- 
sue, we will perceive the necessity of being very re- 
served in the employment of the disturbing method in 
treating the irritation of these membranes, and even of 
the viscera in their vicinity. These means are not to be 
used except with a caution which should never be re- 
garded as timidity. Since Hecquet, Chirac, Baglivi, 



48 INTRODUCTION, 

Rega, Van Swieten, Pomme, and so many other obser- 
vers have exposed the fatal effects of the abuse of these 
means in the treatment of internal irritations ; since the 
anatomical labours of M. Prost have confirmed the state- 
ments of these high authorities; — finally, since M. Brous- 
sais has demonstrated what these authors discovered, it 
is no longer allowable to administer empirically these 
powerful agents, in every case in which the weakness of 
the muscular system seems to indicate their use. 

148. Yet the disturbing method has been employed 
externally with incontestable success, and this has led to 
the presumption that it may sometimes be resorted to in- 
ternally with advantage, with the exception of rubefa- 
cients, vesicatories, and escharotics, which, however, 
some physicians do not hesitate to prescribe in this man- 
ner. This presumption is converted into certainty by 
a small number of facts, which have hitherto been badly 
interpreted. 

149. Intermittent irritation should be treated accord- 
ing to the same principles as continued irritation, but 
during the intermission, we may apply to the organ sti- 
mulants, which prevent the return of irritation, and we 
even sometimes cause its disappearance, by applying sti- 
mulants to the organ at the instant when it is irritated. 
This last case is analogous to those in which the same 
means cures a continued irritation : experience, however, 
appears to demonstrate that in certain internal intermit- 
tent irritations, we may resort to this method in prefe- 
rence to any other to save the life of the patient.* This 

* This passage, which dates from 1823, is a reply to those persons, who, : 
whether with bad or good intentions, criticize without reading, and impute 
absurdities to authors, whose success annoys them : it is time that prejudice 
and ignorance should cease to accuse us of being ignorant of the results of 
experience in the treatment of intermittent diseases. 



INTRODUCTION. 49 

peculiarity forms no exception to the principles which 
have just been laid down. 

150. The rules which govern us in the treatment of 
irritation, are those which we should follow in the treat- 
ment of astheny, which depends directly on irritation; 
but when it is primative, when it persists after the irri- 
tation, when it menaces the life of the patient, in con- 
sequence of the seat which it occupies, it claims the at- 
tention of the practitioner and presents special indica- 
tions. 

151. After removing as far as possible every thing 
that might increase or keep up astheny, we must add to 
the mass of materials which enter into the organism, or 
renew them by the use of good aliment cautiously given, 
if the patient has been on an unwholesome or slender 
diet, we must restore the stimulants of which the organ 
has been deprived, and apply to it medicinal substances, 
stimulants and tonics, commencing with small doses, and 
gradually augmenting them. When the organ cannot be 
placed in contact with these therapeutic agents, we ap- 
ply them to the skin, or the mucous membranes, that the 
impression produced, may be propagated to it. When 
we act upon the skin, we frequently have recourse to 
rubefacients, vesicatories, and escharotics. Adventu- 
rous practitioners do not fear to employ internally, sub- 
stances which are not less active, and the effects of which 
are often fatal. 

152. We may act upon several organs at a time, even 
when the weakened organ is so situated that nothing pre- 
vents our acting directly upon it. We may even have 
recourse to the stimulation of several organs, when as- 
theny appears to extend to the whole organism: we must 
then, however, avoid the parts which might be suscep- 
tible of irritation, under the influence of stimulants. 

7 



50 INTRODUCTION. 

153. In the direct administration of these means, we 
must never forget that a weakened organ is often very 
accessible to the influence of the causes of irritation, and 
that what is employed under the title of a medicine, may 
become a destructive agent, particularly when applied to 
the mucous membranes; for we generally run very little 
risk in stimulating, even very energetically, the skin. 

154. When it is proposed to stimulate a weakened or- 
gan, it is important to inquire whether there be not in 
some other part of the organism, some irritation which 
may be sympathetically increased; we must particularly 
avoid applying stimulants to a part which is already ir- 
ritated, or has formerly been so to a high degree or in a 
permanent manner. 

155. Stimulations, of too active a kind or too often 
repeated, exhaust the excitability instead of reviving it, 
when they do not excite irritation. 

156. The preceding remarks relate to the direct anti- 
asthenic method, local or general. The direct treatment 
of irritation, in consecutive astheny, constitutes the indi- 
rect anti-asthenic method, opposed to the derivative me- 
thod of irritation. 

157. Should the success of this method be considered 
as proving that the irritation of one organ depends some- 
times on the astheny of another, the conclusion would be 
just. In certain cases, indeed, a cure is effected only in 
consequence of the strengthening of a weakened organ 
this is what occurs, when at the commencement of an at- 
tack of fever, occasioned by the impression of cold, the 
fever is made to cease by heating the skin. But the case is 
different when to cure an irritated organ, we stimulate 
another organ, whose action is in no respect weakened : 
in this case there is a real derivation. 

158. Astheny has not hitherto been studied in each 



INTRODUCTION. 51 

organ. It is desirable that this important point should 
be made a subject of research: we should then discover 
to what point the intermittent astheny of an organ may 
contribute to the production of periodical diseases; and 
we should know whether every alteration of texture is 
dependent entirely upon irritation, as is thought by some 
pathologists, or is entirely independent of it, as others 
believe; the elucidation of these points would throw 
light upon the therapeutics of these maladies, which are 
as yet abandoned to empiricism. 

159. If acceleration and slowness of organic action, 
if irritation and astheny, never resulted in any thing 
more than disturbance of function, the principles which 
have just been laid down would suffice for all cases of dis- 
ease which could present themselves. But to the afflux, 
which is the effect of irritation, to the congestion which 
follows astheny, often succeed profound alterations in the 
texture of the organs. 

160. These alterations may, in my opinion, persist af- 
ter the irritation or astheny has ceased. These two mor- 
bid states frequently return and alternate with each other 
in the affected organs. It is then necessary to show what 
course the practitioner should pursue in a case, the treat- 
ment of which is so difficult and inefficacious, and may 
so readily prove injurious. 

161. Unequivocal signs of irritation frequently accom- 
pany alterations of texture; vital action often appears to 
be in no respect deranged in the organ affected; more 
frequently, however, its functions are languid, of what- 
ever nature the derangement of vital action may at first 
have been. Often, after the lapse of an indefinite peri- 
od, high irritation occurs in the altered tissue, and death 
is the consequence. 

162. Since most of the alterations of texture develope 



52 INTRODUCTION. 

themselves under the direct or sympathetic effect of sti- 
mulating causes, it is proper, in most cases, to oppose to 
them the means appropriate to the treatment of irritation : 
this is often requisite even when every thing appears to 
announce the astheny of an organ. We should here re- 
call the distinction, established between astheny of func- 
tion, so often consecutive to irritation, and astheny of nu- 
trition, so unfrequent in general, although it is more com- 
mon in chronic than in acute diseases. But it is not upon 
the anti-irritative local method that we must insist : re- 
gimen, derivatives, and sometimes stimulation of organs, 
very near the affected one, constitute the means to which 
we must have recourse, with the precaution of discon- 
tinuing our measures, as soon as the signs of irritation 
reappear or increase. It is remarkable that in a small 
number of cases, this irritation is renewed with advan- 
tage, provided it be for a very short time, and be prompt- 
ly remedied by the anti-irritative method. 

163. In the treatment of alteration of texture, the lo- 
cal treatment rarely suffices to act efficaciously, upon the 
diseased organ; to renew its composition it is necessary 
in some sort, to renew the composition of the whole or- 
ganism. 

164. It must not hence be concluded, that the mani- 
fest local lesion is connected with a general latent lesion; 
but only that we cannot act profoundly upon the nutri- 
tive action of an organ, but by acting upon that of all 
the others; since to effect this end, it is necessary to mo- 
dify chylosis and hematosis, and to excite in diverse or- 
gans a sur- excitation which occasions the diminution of 
local irritation, to which the alteration of texture is al- 
most always primitively to be referred. 

165. General organic lesions, then, exist no more than 
general vital lesions: there is, however, this difference 



INTRODUCTION. 53 

between organic and vital lesions, that in the latter, it 
is often sufficient to act upon the diseased organ, while 
in the former, it is almost always necessary to act upon 
several points of the organism at the same time. 

166. There are, it is said, general diseases, since cer- 
tain maladies are occasioned by an alteration of the blood, 
as a general lesion of the nervous or sanguine system. 
What are these diseases? what are these alterations of 
the blood? are these alterations unconnected with a pri- 
mitive state of the organs? and, in the first place, what 
is the normal state of the blood? Until these questions 
have been answered, we must adhere to what we know 
of the organic solids, rather than have recourse to ima- 
ginary hypothesis, concerning the fluids which they con- 
tain. As to general lesions of the nervous system, are 
there any which do not commence by a nervous filament 
or by one of the centres of this system? Who denies 
the generalization? But who does not know that it can- 
not be primitive in an assemblage of so many parts, sub- 
jected to influences, all differing from one another. As 
to general lesions of the vascular system, there is no 
proof that they are ever completely so ; in proportion as 
it is uncommon to see them apparently primitive, so is it 
frequent to see them secondary. 

We disavow no fact of humeral pathology, whether 
nervous or vascular ; but wish to establish a science of 
diagnosis and indications, based upon some rare facts, 
some groups of symptoms, separated from their antece- 
dents, and some autopsic examinations: this is to make a 
system, and to act in the very manner which our adver- 
saries so strenuously reprobate; this is to rush into dark- 
ness, while they applaud themselves as alone possessed 
of light. 

Let us study the physiology and pathology of each or- 



54 INTRODUCTION. 

gan, and classify under each organ the facts which he- 
long to it : if we discover any thing positive with regard 
to the blood, or any other of the fluids, let us refer it to 
the physiological and pathological history of the organs 
which elaborate and carry them. If this natural course 
were adopted, the deficiencies of our knowledge would 
be perfectly apparent, and would be remedied as science 
advanced. 

166. From the general remarks which have been made 
we may conclude, 1st, That every disease is local; 2dly, 
that every disease is, primitively, an irritation or an as- 
theny; 3dly, that these two morbid states may co-exist 
in the same subject in different organs; 4thly, that they 
may succeed each other in the same organ; 5thly, that 
to treat diseases successfully, we must go back to the ir- 
ritated or weakened organ, whose influence is felt by the 
economy; which organ it is generally necessary to debi- 
litate, though sometimes to stimulate, directly or sympa- 
thetically; 6thly, finally, that intermittent diseases and 
alterations of texture should be treated according to the 
same principles as continued acute diseases, with the ex- 
ception of the modification which results from their more 
or less rapid progress, their degree of danger, the inter- 
mission which permits us to act in the absence of the \ 
disease,* or the profound and permanent shock which j 
the texture of the organ has sustained. Besides these r 
rules for the treatment of disease, we may mention those ' 
happy and indescribable inspirations, which belong to 
consummate experience and a rare degree of skill; inspi- 
rations, which should never be erected into rules, and \i 
whose results should not be opposed to those of general 
observation. 

* Journal Universelle des Sciences Medicales, tome 7, page 248, 






INTRODUCTION. 55 



167. The art of observing, says Senebier, consists in 
, penetrating the qualities of the subjects which we stu- 
dy, in tracing their effects, seizing their resemblances, 
and their differences, discovering their relations, and de- 
termining the cause of a given effect, from the different 
conditions of this effect, or its analogy to other effects. 

168. Experience, says Zimmerman, is the knowledge 
of the art of curing, which is acquired from judicious 
observations, and experiments; it presupposes the histo- 
rical knowledge of its object, the capacity of remarking 
and distinguishing all the parts; erudition furnishes his- 
torical knowledge; the spirit of observation teaches us 

\ to see, and genius to draw conclusions. To have seen 
much, then, does not constitute experience; the simple 
inspection teaches nothing, nor yet is the attentive ob- 
servation of a fact what is meant by true experience : it 
is only a most happy organization, and a philosophical 
spirit that can qualify us to seek it in the works of the 

I learned, and in the bosom of nature. 

169. Theory is the knowledge logically arranged, of 
all the phenomena which we observe in the organs during 
life, and after death. A theory which should connect 
together the scattered facts of medical science, would 
render, says Darwin, men endowed with mediocrity of 
talent, capable of exercising the healing art; it would 
likewise render it possible to distinguish the true disci- 
ples of medicine, from those who have nothing in their 

| favour but impudence and address : reflection is theory. 

170. True practice is the exercise of the art of ob- 
| serving and treating diseased organs, under the inspira- 
1 tion of knowledge and reflection. 



r 



PHYSIOLOGICAL PYRETOLOGY. 



At que hercle magna qufestioresse potest an flon cssentiales febres peculiarem affectionem 
partium aliquarum internarum sequantur. Baillou. 



CHAPTER I. 

Of Fevers in General. 

Pathological Anatomy has revealed the seat and nature of a 
great number of diseases, and, in many of them, its decisions have 
been incontrovertible; but autopsic examination does not always 
discover manifest organic alterations. Disease has been divided 
into two classes, of which one comprehends all the affections 
which depend on organic modifications, discernible after death, 
and the other all those which leave no sensible traces of their 
existence.* Nervous diseases and fevers have been comprehend- 
ed among the latter. To guide him in determining the nature 
and seat of a disease which terminates happily, or which leaves 
no trace after a fatal termination, the physician has the physio- 
logical analysis of the symptoms, the causes of the disease, and 
the effects of treatment. Thus, the study of the causes, the symp- 
toms, and the traces of disease, as well as of the effects produced 
by the therapeutic agents, and the comparison of these diverse phe- 
nomena with those of the organic modifications in a state of health, 
constitute the whole method to be followed in investigating the 

* Anatomie Pathologique, dernier cours de Bichat, Paris, 1825, in 8vo. 

8 






58 PHYSIOLOGICAL PYRETOLOGY. 

nature, seat, and treatment of disease. But this method should 
be applied in its whole extent; otherwise the knowledge acquired 
is imperfect, or our researches result in error. To seek the in- 
dications so fulfilled exclusively in the causes, the symptoms, the 
morbid traces, or the properties attributed in the schools to me- 
dicines, is to contract the field of observation, to abridge the data 
from which our conclusions must be drawn, and to reduce prac- 
tice to certain systematic or routine views. 

Considered in their symptoms alone, there are some diseases 
whose phenomena are so characteristic that we cannot fail to 
recognise their nature and seat. Such are pneumonia, coryza, , 
pulmonary cataarh, &c. These diseases are few in number, and [ 
in some of their shades it is not always easy to determine the seat 
of the affection. There are other diseases whose symptoms have 
not hitherto led to a knowledge of their seat and nature, or ra- 
ther, whose symptoms, badly interpreted, have often led to mis- 
taken views as to their nature and seat. Among these are fe- 
vers, with the consideration of which we shall be exclusively oc- 
cupied. 

In the writings, which bear the name of Hippocrates, there is [ 
nothing resembling the manner of considering fever, which has 
been prevalent in latter times. When the Hippocratic school 
made use of the words, 7rv$, irv{eros 9 they never intended to desig- 
nate a class, a genus, a species of disease, but only a symptom: 
viz. the burning heat of the skin;* and if they often employed 
these two expressions without particularizing the other symp- 
toms, it was because they naturally reminded them of most of 
those which ordinarily accompany the morbid heat.t It is only 
in the writings of Galen that the word vvgeros is used in the sense 
which the Latins have given to the word febris and which we 
have so long assigned to the word fever. Let it be remarked, that 
patients, and even physicians, use the latter word in the same 
sense in which Hippocrates employed the word we have just 

* Qui primi omnium medicinse initia et quasi fundamenta jacerunt, quam . 
ipsi rudem adhuc et incultam rerum cognitionem haberunt, nomina morbis 
confixerunt, non ex rei essentia, cui primum et maxime medemur, sed ex eo 
quod serte primum occurreret. Fernel, 1656, in 4to, tome II. page 58. 

f If the word fever be still retained in the language of science, it is desira- 
ble that this signification alone should be attached to it. 



OF FEVERS IN GENERAL. 59 

mentioned. Thus, when a patient experiences heat of the skin, 
and when the physician observes this symptom, they both pro- 
nounce the word, fever, without attaching to it any other idea 
than that of the heat which exists. Hippocrates does not appear 
to have contemplated a division of fever, according to their 
symptoms, by the expressions phricodes, lyngodcs, lypyriennes, 
ardenteSj et epiales, which occur so frequently in his writings; 
he did not intend to designate so many distinct species of fever. 
Nosologists have in vain endeavoured to refer these pretended 
species of fever to those which were known to them.* 

M. Broussais appears to have been ignorant that the father of 
medicine did not make of fever an entity, and that essential fe- 
vers are not to be met with in his writings. 

From Galen to the present time, most physicians have applied 
themselves particularly to the study of the diagnosis, the progno- 
sis, and therapeutics of fevers: some have more particularly oc- 
cupied themselves in dividing them into orders, genera, and spe- 
cies; and the paramount importance of determining their nature 
and seat has finally been recognised. The history of pyretology 
might then be divided into three parts, of which the first should 
comprehend symptomatic pyretology, the second, methodic 
pyretology, and the third, physiological pyretology. Thus, 
among physicians, some have laid the foundations of science by 
collecting facts; others have endeavoured to build up the edifice 
of science by connecting facts together according to their resem- 
blance; and, finally, others are persuaded that the only method 
which can conduct to a profound knowledge of fevers, and their 
most efficacious treatment, is to compare the patient with a man 
in health, and the febrile symptoms with the traces discernible 
in the organs after death; to seek for the organ in which resides 
the focus of these morbid phenomena, and to determine the 
means most proper to remedy the lesion of this organ. The 
utility of investigating the nature and seat of fevers has always 
been recognised; but physiology and anatomy were, in former 
times, too imperfectly understood to enable physicians to de- 
rive much advantage from researches of this kind, the prosecu- 

* Laennec ; Propositions sur la Doctrine d'Hippocrate, relativement a la 
Medicine Pratique ; Paris, 1804, in 4to, p. 19. 



60 PHYSIOLOGICAL PYRETOLOGY. 

tion of which forms the distinctive character of the modern 
French medical doctrine, as presented by M. Broussais. 

Fevers are so numerous and so different in appearance that it 
would be impossible to give a general description of them. 
There is not a single derangement of function or of tissue; which 
may not be observed in some of these maladies. They have then 
no specific symptom or pathognomonic sign: the acceleration of 
pulse cannot be given as such, for it is present in diseases which 
are not fevers, and in certain fevers it is absent. 

We can, however, arrange under different heads the phenomena 
which we most ordinarily observe in fevers on account of their 
analogy, their frequent co-existence, their real or apparent de- 
pendence and their habitual succession. 

Thus, sometimes we observe heat of skin, force and frequency 
of pulse, extreme exaltation of sensibility, excessive irritability 
of certain parts, and even inflammation of some particular part: all 
those symptoms, in fine, which announce a well characterized re- 
action. Sometimes, on the contrary, the skin is cold, the pulse 
languid, the senses blunted, and the sensibility as it were annihi- 
lated; certain tissues appear no longer to react under the influence 
of stimulants: in a word, every thing appears to announce pro- 
found weakness. At other times we observe an embarrassing 
alternation of the phenomena which denote reaction, and of those 
which characterize organic weakness. 

This abstract view of the febrile symptoms has led to the esta- 
blishment of the following species of fever; viz. 

The inflammatory, sanguine, sthenic or irritative fever; syno- 
cha. 

The putrid, asthenic or adynamic fever; synochus. 

The malignant, nervous, ataxic or typhoid fever: febris 
at act a. 

But sur-excitation, prostration and ataxy do not manifest them- 
selves in a manner so uniform as these names seem to indicate. 
Sur-excitation is found at the commencement of most fevers, 
ataxy at the latter period of a great number, prostration at the 
termination of all those which prove fatal: these two last form; 
rarely occur without having been preceded by reaction, o 
greater or less duration. 

From the earliest times of medicine, it has been known that i: 



OF FEVERS IN GENERAL. 61 

fevers characterized by an intense excitation, this morbid state 
manifested itself by inflammatory symptoms alone, or by inflam- 
matory symptoms united to those which appear to announce a su- 
perabundance of bile and mucosities. The progress of observation 
has shown that excitation is sometimes more highly developed in 
the stomach, and at other times in the secretory apparatus, formed 
by the gastro-intestinal mucous membrane: this observation has 
led to the division of the fever of irritation, into, 

The inflammatory or angiotenic fever; synocha. 

The bilious, gastric, meningo-gastric fever: febris biliosa. 

The, pituitary, mucous, adeno-meningeal ; febris mucosa. 

Very observable differences in the symptoms and course of ty- 
phus have caused this fever to be considered as a remarkable va- 
riety of fever, adynamic and ataxic at the same time. 

With ataxic fevers have been classed the yellow fever and the 
plague or adeno-nervous fever. 

By the combination of these diverse denominations, it has been 
thought, that all the shades of febrile diseases could be indica- 
ted, or, as they are termed, the complicated fevers: hence, the 
name of inflammatory gastric fever, or causus of the ancients: 
gastro-a dynamic fever, mucous ataxic fever, &c. 

When the symptoms of these fevers succeed each other, and 
pursue their course without complete interruption, they are 
called continued fevers. Most of them, at certain hours every 
day, or on certain days, augment in intensity, and the sufferings of 
the patient increases. This transient exaltation of symptoms has 
received the name of paroxysm or exacerbation, according as it is, 
or is not preceded by a rigour, followed by heat and sweat: the 
symptoms of reaction alone ordinarily undergo this increase of 
intensity. We likewise give the same name to the appearance of 
these symptoms, when at certain hours, or on certain days, fixed 
or indeterminate, they temporarily take the place of other symp- 
toms, instead of only surpassing them in intensity and mingling 
themselves, so to speak, with them. In those cases in which the 
paroxysms return at periods which are fixed, or nearly so, the 
disease continuing in the intervals which separate them, it re- 
ceives the name of intermittent fever. 

Fevers abandoned to themselves, or subjected to treatment, con- 
tinue during some days, often one or more weeks, rarely more 



62 PHYSIOLOGICAL PYRETOLOGY. 

than a month and a half: if they continue for a longer time, they 
lose the name of fevers, and are referred to diverse chronic dis- 
eases. 

There are other fevers which last only for the space of one or 
more hours, cease for one or two days; return, cease again, 
re-appear at fixed epochs; and thus continue to appear by pa- 
roxysms, separated by intervals of health: these are intermittent 
fevers. These fevers terminate naturally or by the aid of art, 
after the occurrence of some attacks, or they pass into the con- 
tinued type, or they became suddenly fatal; or, finally, they pass 
into the chronic state, and are prolonged indefinitely: on this 
account, they have been divided into benignant, pernicious, and 
chronic. 

To these fevers must be added the hectic fever, which is at 
first intermittent, afterwards continued, and often remittent in 
its type. The hectic fever is the constant concomitant of a 
great number of hectic affections. Such have been the most 
general results of the exclusive study of symptoms; nothing 
connected with this subject has been neglected; their analogies 
and their differences have been subjected to an analysis more or 
less happy in its results. Every thing relative to the invasion, the 
type, the progress, duration, and termination of these diseases, 
has been noted with a diligence worthy of all praise; but the 
only manner, in which their proximate cause has been inves- 
tigated, has been by seeking for it in the humours, the principle 
of life, and the vital forces and properties. In the midst of these 
idle discussions, occasioned by researches so badly directed, the 
seat and nature of fevers remained nearly unknown. 

The connexion established by the ancients between symptoms 
and morbific causes, was based upon pure hypothesis. All re- 
searches with regard to that connexion, which physiology reveals 
and pathological anatomy confirms, has at length been neglected, 
despised, and even proscribed. The causes of each species of fever 
have been confusedly accumulated in the general description of 
the disease, without any attempt to determine upon what organs 
they primitively exerted their influence, or how this influence, 
always local at first, is propagated to a greater or less extent to 
the rest of the organism, according to the age, the sex or the 
predisposition of the individual. 



FEVERS IN GENERAL. 63 

In consequence of this vicious method, nothing has heen seen 
! in fevers from their very commencement but irritation, ady- 
namy, and ataxy, invading the whole organism. No attention 
has been given to the important fact, that in most fevers, one 
part of the economy is generally in a state of manifest excitation, 
while the rest of the organism is languishing or suffering 
from a combination of excitation and weakness, difficult to ex- 
plain without the aid of physiology. On the appearance of the 
signs of prostration, those of excitation which have preceded them 
or which still continued, are immediately forgotten. Farther- 
more, every external local irritation, well developed, incontesta- 
ble, with some signs or even without any sign of reaction in the 
circulatory system, whenever it appeared, ceased, and reappeared, 
at fixed epochs, in the manner of the attacks which constituted 
intermittent fevers, has been regarded as a general febrile dis- 
ease, disguised under the appearance of an affection purely local, 
i and according to this strange theory, has been established the 
'] genus of masked intermittent fevers. This is undoubtedly the 
j most striking example of the abuse of analogy and the most 
forced of all the classifications attempted by the human mind. 

All this is to be attributed to the exclusive and superficial 
study of symptoms, to which too much importance has been as- 
| signed, to a vicious and forced generalization of ideas, to the 
rejection of sound physiological reasoning; to the want of an etio- 
logy founded upon a just comparison of the phenomena of health 
and those of disease, to preconceived ideas of the nature and seat of 
fevers; to negligence in making autopsic examinations, to the 
indifference and even fear manifested with regard to this mode of 
investigation, in the case of fevers, and, to sum up all in a few 
words, to the separation of physiology, pathology, and therapeu- 
tics, and especially to the imperfection of pathological anatomy. 
The science of man is undoubtedly so vast that to facilitate its 
study it must be divided. But the result of this indispensable divi- 
sion has been, that each individual has confined himself tothat part 
of the science which best accorded with his peculiar turn of 
mind, or to the cultivation of which he had been led by circum- 
stances. The progress of one part of the science has been totally 
devoid of any beneficial bearing upon the advancement of the 
other parts. Errors have thus passed uncorrected; and, strange 



64 PHYSIOLOGICAL PYRETOLOGY. 

to say, science itself has at last been considered as not only insuffi- 
cient, but even pernicious in the exercise of art. The greatest 
service rendered to medicine by M. Broussais is his having de- 
monstrated the necessity of a union of all the branches of the 
science of man. 

The progress which science has made since the promulgation 
of this grand idea, has induced many physicians to acknowledge 
that in the midst of this general disturbance, which, according to 
them, characterizes fever, every point of the economy is not 
equally affected; but they assert that the local affection which 
appears to dominate, and which most generally leaves unequivo- 
cal traces after death, is nothing but a dependent affection, a con- 
sequence or effect of the general affection, always primitive, which 
constitutes fever; as if hepatization of the lungs, observed in the 
dead body, were to be attributed to the heat of the skin, the force 
and frequency of the pulse, and the cough observed during life in 
the course of pneumonia. 

Pinel has rendered a signal service to science, in divesting 
pyretology of the antiquated theories in which facts had been bu- 
ried, and by continually directing the attention by his advice, by 
his example, in his writings, in his course and at the bed-side, to 
the observation of phenomena. By classing together in six dis- 
tinct groups the febrile symptoms which ordinarily manifest them- 
selves together, or in an order of succession little liable to change, 
he established six orders of fevers, the characters of which were 
more clearly traced than those of the different fevers admitted in 
the ancient schools. He has thus carried to its highest degree 
of perfection what he denominates nosographic pyretology. He 
has done more: he has endeavoured to refer some of these orders 
of fevers to the part of the body which appeared to be particu- 
larly affected in them. He would have advanced farther in the 
path of truth, which he himself had opened, if, not content with 
having given to fevers denominations founded upon certain ex- 
ternal appearances, and upon the signs of certain functional lesions, 
denominations which, he says, are by no means designed to ex- 
press the nature of these maladies, he had known all the impor- 
tance of an investigation of their seat; if he had devoted himself 
with ardour to this investigation, instead of presenting it as the 
object of a curiosity purely speculative; as a mere recreation of the 



FEVERS IN GENERAL. 65 

mind, and as perfectly destitute of any practical bearing. At 
all events he has done too much to allow the reproach of not 
having done more. 

Since 1798, his pyretology has been in the hands of all the 

French physicians; it has been naturalized in Spain; the Hippo- 

cratic physicians of Germany have bestowed upon it merited 

praises; those suffrages are based upon the incontestable services 

' which this learned professor has rendered to medical science, in 

perfecting the art of describing and classifying disease, rather than 

upon the actual merit of this production, which has suffered the fate 

reserved for every scientific work, after the lapse of a number 

of years. It still, however, serves either tacitly or avowedly as 

i the basis of instruction in the school of medicine of Paris. A 

great number of physicians, who do not openly adopt it, have 

no other views on the subject of fever than those of Pinel. 

We may regard his book as the expression or summary result of 

most of the works, undertaken on the doctrine of fever, until the 

year 1814; but since that period pathology has made an immense 

I progress, by its more intimate union with physiology, and by the 

: progress of many branches of pathological anatomy. 

It is time to introduce into the body of science the researches 

which have been made during some years past with regard to 

; the seat and nature of fevers. A physician who would present 

! the actual state of pyretology should take for his point of de- 

j parture the work of Pinel. Every other plan, in place of af- 

| fording new light to the practical physician, and offering a faith- 

| ful guide to the student, placed between two different doctrines, 

would only disturb the ideas of the one, and place the other in a 

painful state of uncertainty, or occasion an unjust contempt of 

one or other of the two doctrines, or even, what would be more 

dangerous, give rise to the opinion, that medicine has no fixed 

principles, and is only a changeable product of the imagination. 

In the remarks which have just been made, we have pointed out 

the object and plan of this book. 

I shall not confine myself to the province of the historian. 
I shall search for truth among the contending parties. Our 
object is not to advocate the views of particular professors, but 
to borrow from one his method of observation, and from 
another, his ideas upon the investigation of the affected organs, 

9 



56 PHYSIOLOGICAL PYRETOLGY. 

and the alterations which they undergo. The truth of this 
grand principle is no longer contested, we shall not therefore 
stop to demonstrate that we must no longer confine ourselves to 
the study of the invasion, the symptoms, the course, the type, and 
termination of fevers. 

The doctrine of sympathies presented by Hippocrates, disguised 
under the most fantastical forms by Vanhelmont, maintained with 
warmth by Bordeu, calculated by Barthez, developed and or- 
ganized by the genius of Bichat, united with pathological anato- 
my by Broussais, has conducted the latter to the establishment of 
the following principles: 

Every disease is primitively local; 
Like the phlegmasiae, all fevers are only local diseases; 
All fevers are the consequence of gastro-enteritis. * 
The first of these positions, and consequently the second, are 
incontestable; because, 

1st No morbific cause acts at the same time upon all the or- 
gans. 

2dly. The symptoms never extend to all the organs. 
3dly. The symptoms are never equally intense in all the or- 
gans. 

4thly. In diseases which appear to be general, the disorder al- 
ways commences at a single point, whence it extends to others. 
5thly. No disease, how general soever it may appear to be, 
leaves characteristic traces in all the organs. 

6thly. After sudden death, an examination of the body ordi- 
narily shows, that the lesion of a single organ is sufficient to ar- 
rest the action of all the others. 

It should then be admitted, that all the diseases to which we 
give the name of fever are primitively local, and, by analogy, 
those which destroy life instantaneously, as apoplexy does, an 
affection which no one thinks of ranking among general diseases. 

* On this subject, M. Broussais expresses himself in the following manner; 
viz. 

When an organ is sufficiently irritated to light up fever, this effect is never 
produced except through the intervention of the united irritation of the heart 
and mucous membranes, and particularly of the gastric mucous membrane." 
Journ. Univ. des. Sciences, Med. t. viii. p. 143. 

All the essential fevers of authors are to be referred to gastro-enteritis, 
simple or complicated." Deux. exam. 1. 1, n. 34. 



FEVERS IN GENERAL* 67 

But, in our opinion, all fevers are not to be attributed to gas- 
troenteritis, not even all those denominated essential, because, 

1st. The causes of fevers do not act solely upon the gastroin- 
testinal mucous membrane. 

2dly. Although this membrane often receives the direct or 
sympathetic influence of the febrile cause, in the former case, it 
does not always receive it alone, and in the second, it often re- 
ceives it only in a very feeble manner. 

3dly, Every organ, being like this membrane, capable of act- 
ing sympathetically on the heart, the vessels, the lungs, and the 
organs of secretion, upon the nerves, the ganglions, the brain, 
the muscles, &c, can, in like manner, occasion the development 
of the symptoms which we name febrile. 

4thly. It is frequently the case that a careful study of the 
causes, and an attentive examination of the symptoms, demon- 
strate that the gastro-intestinal mucous membrane is sound, or 
too slightly injured to warrant the assertion, that it has provoked 
the development of the malady. 

5thly. Sometimes, we not only do not find any trace after 
death in this membrane, but we discover profound lesions in 
other parts of the body. 

To behold in fevers only an affection, sui generis, invading 
the whole economy, is totally at variance with the actual state 
of pathological anatomy, and physiology;, but, I believe it is 
equally contrary to these two sciences, to lay it down as a princi- 
ple, that there is no fever without inflammation of the stomach 
and intestines. These two opinions, diametrically opposed to 
each other, are very widely spread, because they are exclusive; 
and, consequently, calculated to please superficial and enthusias- 
tic minds. It has been, and still is necessary to combat them. 
Between these two extremes, there are many other opinions, 
which I shall pass in review, and I shall point out those which 
appear to me to have the greatest semblance of truth. 

Such appear to me the principles upon which should be con- 
ducted the study of fevers, in an investigation of their nature 
and seat; that is to say, we should inquire what organs are af- 
fected in these diseases, and what lesion they suffer, by a physi- 
ological analysis of the causes which determine them, the symp- 
toms which characterize them, and the traces which they leave 



6S PHYSIOLOGICAL PYRETOLOGY. 

after death. This work is not devoted to polemical discussion; 
if is in ex: : s:::on of what is taught with regard to the seat and 
nature of fevers, by phenomenology, etiology, physiology, and 
pathological anatomy: it is, in one word, physiological pyrtto- 
logy; in the sense which I attach to this expression, I give this 
work to the public, with the desire that the practitioner may 
fin 1 the means of comparing the results of his clinical la- 
bours with the actual state of pathology, and may be enabled to 
proceed to a new series of observations, calculated to confirm or 
combat the new principles. I likewise indulge the hope that it 
will prove a useful guide to students in their theoretical and prac- 
tical studies. 

A new era is commencing in medicine- The edifice of sci- 
ence is not to be rebuilt, but additions are to be made to it, and 
many parts, which time has destroyed, are to be replaced. It is 
to be desired, that each physician, anxious to contribute to the 
perfecting of the science of disease, should make himself mas- 
ter of a port::: :: Hm ancient pathology, compare with it the 
observations of his predecessors and contemporaries, and the re- 
solts :: bia practice, arrange the whole according to the lights 
furnished by the most recent progress of pathological anat : 
and physiology, and present the facts of which we are possessed, 
in a manner corresponding to the actual state of the medical sci- 
ence. 



INFLAMMATORY FEVERS. 69 



CHAPTER II. 



Of Inflammatory Fevers. 

The words, nvpefos Ivnw, so often repeated in the works that 
bear the name of Hippocrates, do not indicate an inflammatory 
fever, in the sense assigned to this expression at the present day, 
but only a state of continued burning heat. It was only after 
the lapse of time, that the name synocha came to designate the 
species of fever, in which the inflammatory phenomena predo- 
minate over all the others, and appear to extend to the whole or- 
ganism. It has been denominated in succession, synocha or 
continued, simple or not putrid, continent, sanguine, in- 
flammatory; it afterwards received the name of angiotenic. 
M. Recamier has given it the name of the sthenic hematosic 
fever. 

If we collect all that has been written upon the symptoms and 
causes of this disease, we shall obtain the following description: 
the invasion of inflammatory fever is ordinarily announced by one 
or more of the following phenomena; viz., general malaise, hea- 
viness, flushing of the face, nasal hemorrhages, dizziness, verti- 
go, heat in the chest, palpitations, increase of appetite, succeed- 
ed by inappetence, a sensation of weight in the abdomen, con- 
stipation, interruption of the menses, of the hemorrhoidal flux, 
ardor urinae, painful weight in the loins, dryness of the skin, and 
a sense of fulness, tension, and painful swelling of the abdominal 
extremities, when the patient is standing. This state lasts one 
or more days, sometimes a week or more. 

The invasion is almost always sudden, even when it has been 
announced by precursory signs. The subject suddenly expe- 
riences towards the end of the night, or in the morning, a rigor, 
which is sometimes slight or almost imperceptible, promptly 
followed by heat of the skin; this heat, which is habituous 
and mild to the touch, seems to diminish under the pressure of 



70 PHYSIOLOGICAL PYRETOLOGY. 

the hand. The face is red and vultuous, (vultueuse,)* and the 
turgescence sometimes extends to the whole body, the surface of 
which sometimes presents a rosy tint; the eyes are brilliant and 
tearful, the conjunctiva injected, the eyelids tense and painful, 
the patient is troubled with dizziness and vertigo: objects appear 
of a red or very bright colour, a bright light offends the eyes, 
slight noises fatigue the ear, the nostrils are dry, the sense of 
smell becomes obtuse. A painful heaviness is felt in the head, 
particularly at its anterior part, and along the spine. The pa- 
tient is prostrated, he sleeps little, and his sleep is interrupted by 
sudden waking and troubled by dreams; at other times, there is a 
state of somnolence; the intellectual faculties are sometimes dis- 
turbed; the extremities are, as it were, benumbed, or slight con- 
vulsive movements are perceived in them. The tongue is white 
or red, particularly at its point, and on its edges, always moist in 
the commencement, and when the disease is not very intense, 
the lips are dry, and there is a disagreeable taste in the mouth; 
sometimes there is thirst, slight nausea, and sensibility at the 
epigastrium; at other times, the patient complains of none of 
these symptoms: there is sometimes inappetence, sometimes a 
marked disgust for food, two states we must not confound; or- 
dinarily, there is constipation. The pulse is generally large, 
full, strong, accelerated and rebounding; sometimes soft and 
concentrated, when the patient experiences intense pain in some 
part of the body; the carotid and temporal arteries often beat 
with force, and the veins are swelled; respiration is frequent, 
hot, and quick, without being painful. The urine is small in 
quantity, and of a deep red colour in the commencement of the 
disease; afterwards it is more abundant and turbid, and deposites 
a lateritious sediment 

These symptoms, which are never all observed at once, are 
more intense during the evening and night, than in the morn- 
ing. After having lasted during twenty-four hours, two, three, 
four, seven, or fourteen days, they gradually diminish, without 
the occurrence of any evacuation; or there supervene general 
sweats, hot and abundant, hemorrhage from the nose in young 
persons, from the vulva in women, or from the anus in persons 

* This word is used to indicate the state of the face when it is red, and 
apparently swelled. 



INFLAMMATORY FEVERS. 71 

subject to hemorrhoids; an abundant flow of urine, with or with- 
out white sediment; sometimes mucous sputa; more rarely, co- 
pious dejections of matters resembling grounds; recovery then 
takes place in a few days; it occurs almost suddenly after a he- 
morrhage. % 

Convalescence is short and relapses unfrequent. This happy 
termination is not the most frequent; more ordinarily, many of 
the symptoms are observed to increase in intensity, to such a 
degree as to call for all the attention of the physician, and the 
disease is prolonged beyond a week, or even two weeks. It is 
then said that the inflammatory fever is complicated with a local 
inflammation, if there appear unequivocal signs of an afflux of 
blood, or of a phlegmasia in the head, the chest, or the abdo- 
men, or in the skin, or the cellular tissue of the extremities, 
constituting apoplexy, arachnoiditis, encephalitis, angina, pleu- 
risy, peripneumony, pericarditis, carditis, aortitis, angiotitis, 
hepatitis, gastritis, enteritis, nephritis, cystitis, an exanthem or 
phlegmon. 

When the augmented intensity, and the symptoms which su- 
pervene do not appear to announce one of these inflammations, 
it is said that the inflammatory fever is converted into a gastric, 
adynamic, cerebral, ataxic, ataxo-adynamic, yellow, typhoid 
or pestilential fever, according to the character of the predomi- 
nant symptoms. 

The inflammatory fever then terminates in health or it changes 
its name, and it is thus that it is said never to occasion death 
but when it determines the inflammation of an important organ, 
or is converted into another malady. 

Practitioners recognise three varieties of inflammatory fever; 
viz: 1st, Ephemera, the symptoms of which have little intensity, 
often terminates without evacuation, sometimes by a slight per- 
spiration, a simple moisture of the skin, by fecal discharges or 
an inconsiderable hemorrhage, after having continued 20 hours, 
1, 2, 3, 4, days or more; 2dly, Synocha or inflammatory fever, 
properly so called, the symptoms of which are very strongly de- 
veloped, and which does not terminate without an evacuation, 
either occurring spontaneously or produced by art, and which 
lasts one or two weeks; 3dly, grave synocha or inflammatory 
fever, in which the pulse seems depressed at the same time that 



72 PHYSIOLOGICAL PYRETOLOGY. 

it is hard, the limbs are benumbed, the prostration is extreme, 
and the tongue dry and brown. These varieties are only shades 
or degrees, or the result of the extension of the same malady. It 
is proper to mention them, but it would be irrational to confine 
to this division our analysis of the symptoms of inflammatory 
fever. 

These three varieties of inflammatory fever differ not only as 
it regards intensity of irritation, but as it regards the seat of dis- 
ease. In one of them, for example, the third, the heart is more 
strongly affected than in the two others; perhaps it is even- in- 
flamed in this variety, whilst in the two others, and particular- 
ly in the first, it is only irritated, strongly sur-excited. 

Inflammatory fever is most frequently sporadic, but it may 
likewise affect a great number of persons at one time, in the sea- 
sons and in the countries which favour its development, and 
thus become epidemic or endemic. 

With regard to the prognosis, we must say with Pinel, that 
it is always favourable, with the exception of the cases in which 
the symptoms increase in intensity in any particular point of 
the organism, in such a manner as to threaten a phlegmasia, or 
such a violence of febrile reaction as may occasion death. 

For a long time the manifestation of the symptoms of inflam- 
matory fever was attributed to a superabundance of the blood, or 
only of its red part, to the friction of this liquid against the walls 
of the vessels, to a spasm of the small vessels of the skin, or to 
tension of the vascular fibres. At the present day there is but 
one opinion with regard to the nature of this fever. All agree 
that the phenomena which characterize it, depend upon a sthenia, 
an excitation, an irritation, an angiotenia, a hyperemia, oran 
inflammation, synonymous words, which designate an excess of 
vital activity in the affected part or parts; whence arise, exalta- 
tion of sensibility, pain, acceleration of pulse, the temporary sus- 
pension of some secretions and augmentation of others, weakness 
or oppression of muscular force. We shall not here stop to exam- 
ine how well founded are the arguments of the physicians who 
admit an essential difference between the irritation which deter- 
mines an essential fever, and the inflammation which gives 
rise to a symptomatic fever: what is to be said upon this subject 
will more properly find its place in the chapter appropriated to 



INFLAMMATORY FEVERS. 73 

the comparative study of the essential and symptomatic fevers. 
Another course could not be followed without giving rise to 
repetitions on the occasion of each fever. 

If there be a general agreement with regard to the nature of 
the lesion, which gives rise to the symptoms of inflammatory 
fever, this harmony does not equally exist with regard to the 
seat of this lesion. Some physicians, judging from the aspect 
of the patient superficially examined, think that the lesion occu- 
pies the totality of the body, although there is not always, and 
in every part, an augmentation of action, since the secretion 
of urine is at first suspended, the muscles contract with difficul- 
ty, the pulse is sometimes soft, concentrated, and small, and the 
cerebral functions less active. 

Many physicians, while they admit a universal irritation, ac- 
knowledge that it is more manifest in the sanguine system, consi- 
dered in a general manner; others limit it to the arteries, some to 
the heart, some to the great vessels, many to the sanguine capillary 
systems. It is considered by some as involving the whole circu- 
latory system, but the general and uniform irritation of all the 
organs is not less chimerical than the tamper amentum tempera- 
turn. M. Broussais asserts, that it occupies, primitively and 
specially, the mucous membranes, particularly the gastric mucous 
membranes. M. Alard places it in the skin and sub-cutaneous 
cellular membrane. * 

" Synocha," says Brown, " is nothing else than a phlegmasia, 
composed of a sthenic diathesis, insufficient to light up an inflam- 
mation, and of a pyrexia; what is peripneumony, rheumatism, or 
any other phlegmasia, but a synocha, with a diathesis sufficiently 
strong to produce an inflammation?" "What," says Tomasini, 
" is synocha, but a slight degree of phrenitis, of angina, or of rheu- 
matism?" Reil attributed synocha to an exaltation of the irrita- 
bility of all the sanguine vessels, arterial and venous, with 
integrity of action. 

In the epidemic of Nantz, Bagard proved by post mortem ex- 
aminations that the prevalent inflammatory fever was but a peri- 
carditis. J. P. Frank ascribed inflammatory fever to irritability 
and augmented action of the heart and arteries. In violent inflam- 

*Du Siege et de la Nature des Maladies. Paris, 1821. in 8vo. tome II. p. 28. 

10 



74 PHYSIOLOGICAL PYRETOLOGY. 

matory fevers, with extreme agitation of the heart and vessels, 
he remarks. •'• We have, for the hrst time, observed a deep and 
inflammatory redness on the internal surface of these vessels. 
and even of the whole venous system: we have had many op- 
portunities of showing, under the same circumstances, partial 
phlogosis, commencing; with the aorta.'-' In the pathological part 
of the article Heart, of the Dictionnaire Abrege des Sciences 
Medicates, I made the following remarks in 1521, viz.: 

•'•'The irritation of this organ has hitherto been described un- 
der the name of simple fever, of inflammatory fever, or epheme- 
ral svnocha: it is found in the highest degree in synocha, pro- 
perlv so called, and in all the fevers characterized by the symp- 
toms of an acceleration of the circulatory movement,'' M. 
Bouillaud, in his interesting Treatise on Diseases of the Heart, 
published in 1 824, does not hesitate to say that there almost always 
exists an irritation more or less considerable of the aorta, when- 
ever a fever of an extremely violent character is developed, but 
that in this case it is not only the aorta, but the entire circulatory 
system, and the heart itself, that partakes of the irritation. He 
has observed the red ramollissement of the heart, after graver fe- 
vers of a very violent character. M. Bouillaud thinks that the seat 
of inflammatory fever is in the system of the heart and sanguine 
vessels.* •• This disease consists essentially,*' says he, •' in an in- 
flammation or simple irritation of the circulatory apparatus; it 
bears the same relation to this apparatus in general, that a local 
phlegmasia does to the sanguine capillaries of the organ in which 
it is seated; the latter is, so to speak, but a local fever, while 
the former is a general one. What proves, according to him, that 
this comparison is correct, and that the facts in these two cases 
are identic, is, that the former in the majority of cases, is derived 
solely from the extension, the generalization of the latter, that is 
to say, it is a local phlegmasia, which has become general, either 
through the intervention of sympathy, or in some other manner: 
whence he concludes, that inflammatory fever is nothing but 
fever, properly so called, considered in a general and abstract 
manner. M. Bouillaud has examined with much care the red- 
ness presented by the internal surface of the heart, the arteries, 

' Traits Clinique des Fievres. Paris, 1826, in Svo. chez J. B. Baliere. 



INFLAMMATORY FEVERS. 75 

and the veins, in an extent more or less considerable; he regards 
them as appearances peculiar to inflammatory fever, either simple 
or complicated, with some other phlegmasia. " As to the altera- 
tion of the blood in inflammatory fever, we only know," says he, 
" that blood taken from the veins, is hotter, thicker, and more co- 
agulablc than in health; that it is almost immediately covered by a 
grayish or whitish crust, of variable thickness, and known by the 
name of the inflammatory crust. To support these opinions, he 
cites three cases, in which the subjects, having presented symp- 
toms of inflammatory fever, there were found traces of phleg- 
masia in the heart and aorta, in the first and second; in the heart, 
the arteries and the veins, in the third. But the first presented, 
likewise, traces of meningitis and bronchitis, and the lungs were 
gorged with blood; the second presented traces of pleuropneu- 
monia; the stomach and duodenum, as well as the small intes- 
tines, exhibited traces of inflammation in the third. There is 
no doubt that inflammation of a part of the sanguine vascular 
system, particularly if it be of any extent, may give rise to the 
phenomena of inflammatory fever. But it cannot be denied 
that these same phenomena may be produced in a subject, pos- 
sessed of exquisite sensibility, or of great vascular energy, by a 
local inflammation of slight intensity, and very limited extent, 
by the mere propagation of irritation to the heart, without the 
existence of a real phlegmasia during life, and without the ap- 
pearance of redness after death, in the irritated part of the 
vascular system. Nor is it at all necessary that irritation should 
extend itself gradually until it reaches the heart. Through its 
nervous connexions, it may be sufficiently excited to beat more 
frequently than in its ordinary state. 

According to M. Andral, the red tint presented by the inter- 
nal surface of the heart and the vessels, in subjects who have 
fallen victims to continued fevers, has nothing to do with the 
production of any of these fevers; it does not even contribute 
to the production of any of their symptoms; this red tint is found 
indifferently at the termination of all diseases, after those accom- 
panied by fever, as well as those unattended by it; it should be 
considered as a phenomenon belonging to the dead body, the 
more or less rapid production of which depends on certain con- 
ditions, which may all be resolved into a single one: the ten- 



76 PHYSIOLOGICAL PYRETOLOGY. 

dency of the body to a more or less rapid putrefaction.* Fur- 
thermore, M. Andral has only six times observed the redness of 
the heart in eighty-six subjects, who had died with all the symp- 
toms of grave fevers. M. Bouillaud has found this alteration 
eleven times in forty -nine examinations; as it respects the ves- 
sels, their redness is mentioned by M. Bouillaud eight times in 
the same number of cases. M. Louis found an unusual redness 
in the heart, three times, and in the aorta twenty times in fifty- 
four subjects, t From the circumstance of this redness being 
observed after various diseases with or without fever, M. An- 
dral concludes that it is unconnected with a morbid state. Yet, 
when we consider that it has been found eleven times in thirty- 
two cases of organic lesions of the heart, it is evident that the 
tendency to putrefaction does not account for it so clearly as he 
appears to think. The vivisection of animals during acute ma- 
ladies, attended by fever, is indispensable to the solution of this 
problem. 

Researches of this kind are the more desirable, since M. An- 
dral, notwithstanding the very decided language of the proposi- 
tions, which we have just cited, has since declared, that the red- 
ness of the heart might occur during life, and be connected with 
an active or passive afflux of blood to this organ. He was con- 
vinced of this by the examination of horses, affected during the 
epizootic malady, in 1824; and which he opened immediately 
after they were killed. MM. Dupuy and Boulay had previ- 
ously made similar observations; and it may be observed, that 
this redness did not present any very marked difference from 
that produced after death, by exposing the heart of a horse to 
the air or sun. Furthermore, M. Andral found a lively redness 
of the internal membrane of the right cavities of the heart, in 
a subject who had died after symptoms of pericarditis, such as 
sudden attacks of suffocation, palpitations, &c; in another, after 
having presented symptoms of hypertrophy of the heart; and, 
finally, in others, who, affected with disease of the heart, had 
died in the midst of an exacerbation, which had suddenly su- 
pervened. It is evident, therefore, that M. Andral was in er- 
ror, when he asserted that the redness of the circulatory passages 

* Clinique, 1830. 

t Recherches Anatomique. Paris, 1829, in 8vo« chez J. B. Balliere. 






INFLAMMATORY FEVERS. 77 

always took place after death. His critique of the opinion of 
M. Bouillaiul, went beyond the truth." 

M. Andral asserts, in the same work, that inflammatory fever 
often seems to recognise no other point of departure than blood 
too rich in fibrine; that this fever is often only an effect of a ge- 
neral sanguine congestion of the gastro-pulmonary mucous mem- 
brane. 

It is proper that the ideas of this author should be mentioned; 
they are remarkable for the uncertainty which characterizes 
them, and which forms a singular contrast to the solidity of his 
anatomical labours. 

According to M. Gendrin, the examination of those who have 
succumbed in inflammatory fever, or fallen victims to a grave 
phlegmasia which it has determined, discovers in every case, or- 
gans more or less affected in their structure, most frequently the 
lungs, and very frequently, also, the gastro-intestinal mucous 
membrane are the organs which suffer. 

It is farther necessary that there should be a large and very 
complete collection of facts, to enable us to decide whether the 
whole sanguineous system can in reality be inflamed; it will then 
be proper to inquire what point of this system is the focus of in- 
flammation. The only principles, which, in our opinion, can be 
laid down upon this subject, are the following, viz. : the more 
hard, full, frequent, and quick is the pulse, the more reason is 
there to suspect inflammation of the right cavities of the heart, 
and of the large arterial trunks; when to these phenomena, we 
see succeed those which have been designated under the name of 
false adynamic fever, without symptoms of gastro-enteritis, we 
have reason to suspect that the inflammation extends over the 
whole heart, that it has become more profound in the tissue of 
this viscus, or even that it extends to a part of the venous sys- 
tem, according to the opinion of M. Ribes, who supposes ady- 
namy to depend on phlebitis. 

It is difficult to pronounce in a positive manner upon this point 
of doctrine, on account of the limited number of facts possessed 
by each observer. When a greater number of facts shall have 
been accumulated, caution will be necessary, lest we fail to no- 
tice organs inflamed simultaneously with the heart and vessels. 

* Precis d'Anatomie Pathologique. Paris, 1830. 



78 PHYSIOLOGICAL PYRETOLOGY. 

This, at least, is certain, that there are inflammatory fevers, in 
which one part only is affected, whilst in others, especially in 
those which reach a very high degree of intensity, the irritation 
extends to many organs, as has been very judiciously remarked 
by Reil: this is easily proved by an analysis of the causes and 
symptoms of inflammatory fever. 

An abundance of blood, rich in fibrine, is one of the circum- 
stances most favourable to the development of the irritation, 
more or less extended, which determines the diverse morbid 
states, collectively designated under the name of inflammatory 
fever. It is caused by an excess of alimentation, or by the pre- 
dominance of the lungs, which is recognised by the florid com- 
plexion and skin, the amplitude of the chest, and the force and 
fulness of the pulse. 

The fulness of the capillary vessels of a single organ, is also 
a circumstance favourable to the development of the irritation 
which produces synocha. This primitive local plethora is often 
found in subjects who are considered weak and languishing, be- 
cause they are pale and thin. It is in these subjects that we 
find cerebral plethora, when they apply themselves assiduously 
to study, or when they suffer from mental anxiety; pulmonary- 
plethora, when the structure of their chests, and the confirma- 
tion of their lungs predispose them to it, particularly if they in- 
dulge to excess in the pleasures of venery. Abdominal plethora 
occurs in persons, and particularly in infants, who eat voracious- 
ly and make use of too substantial a diet; uterine plethora in 
girls, who have not yet menstruated, and in women, at the pe- 
riod of the cessation of the menstrual discharge. Secondary lo- 
cal plethora is observed when persons, who are habitually in a 
state of general plethora, accidentally stimulate one of their or- 



The circumstances which prepare, favour, or determine the 
development of the irritation which constitutes synocha, are the 
following, viz., youth and adolescence, periods of life at which 
the blood is more exciting, and the tissues more excitable, the pe- 
riod of puberty in boys, and particularly that of the commence- 
ment of menstruation in girls, the suppression of hemorrhages, 
and habitual evacuations, natural or artificial, which gives rise 
to an accidental plethora, or prevents its removal; prolonged 



INFLAMMATORY FEVERS. 79 

watching, excessive study, mental disquietude, which acts upon 
the brain, and causes a continual afflux of blood to it; prolonged 
and rapid running, singing, and crying aloud, which strongly ex- 
cites the organs of respiration; the impression of substances which 
strongly stimulate the digestive passages, or any other part of the 
mucous membranes; the sudden cooling of the skin when it is hot 
and moist, which necessitates a vicarious action in the mucous 
membranes; insolation, and every thing capable of irritating the 
skin; the sudden disappearance of affections of this tissue, which, 
according to the experience of all times, influences the internal 
organs; finally, wounds, contusions, and all mechanical lesions, 
which divide, tear, or irritate the skin, the cellular tissue, the 
parenchymatous structure, the membranes, the muscles and the 
bones. 

None of these morbific causes, predisposing or occasional, arc 
the result of an action which affects the whole of the body. 
The predisposing causes reside in the sanguineous system; they 
result from a nutrition, operated by digestive organs, endowed 
with too great rigour. — If general plethora be developed in this 
case, it cannot be said that it is in consequence of a gastritis; for 
the stomach is not excited beyond its physiological condition, 
as long as its functions are performed without embarrassment, 
pain or languor. Besides, general plethora alone is never capa- 
ble of determining synocha; it is necessary that an afflux towards 
some particular organ be established, for these symptoms to ma- 
nifest themselves; it is necessary that the equilibrium be de- 
ranged, from which health results, and this equilibrium cannot 
be deranged but by a great natural excitability, or the acciden- 
tal sur-excitation of an organ. Now, it will be seen, on the 
slightest reflection, that the occasional causes which have just 
been pointed out, act upon some organ in particular. All the 
organs being connected with each other, and with the heart, by 
means of vessels and nerves, the morbific impression acts first 
upon an organ, which sometimes communicates it, as it has just 
been remarked, to the centre of the circulation; and sometimes 
to another organ, through which it is transmitted to the heart. 
In these two cases, the organ primitively affected, often ceases 
to be so, after having transmitted the morbific influence to an- 
other; the same thing sometimes occurs in the case of the organ 



80 PHYSIOLOGICAL PYRETOLOGY. 

which has secondarily received this influence, so that the circu- 
latory system appears to be, and sometimes in reality, is alone 
affected in these instances; and this has occasioned the seat of the 
affections, confounded under the name of inflammatory fever, to 
be placed in this system. 

Sometimes the morbific cause seems to affect more especially, 
the lining membrane of the great vessels, and this is one of the 
causes in which the circulatory system is alone affected; but it 
would be incorrect to have in view only such cases, which per- 
haps are not so common, as they are thought at the present day, 
which moreover are but little known, and which do not exclude 
the morbid state of another tissue. 

When the stomach has received, primitively or secondarily, 
the impression, and it ordinarily receives it simultaneously with 
the heart, on account of its intimate connexion with all the other 
organs, it retains it in part even when it influences the heart and 
sets it in motion. It is then often affected in synocha, but this 
is generally to a very slight degree, and it would be very wrong 
to pay exclusive attention to it, because there would be a risk 
of overlooking the morbid state, often more important, of other 
organs. 

An examination of the patient, proves, according to M. Brous- 
sais, that the capillaries of the skin, those of the cellular tissue 
and of the articulations, are not in a state of phlegmasia. If they 
were, we should have, he remarks, either the symptoms of ery- 
sipelas, or those of the other cutaneous phlegmasia, or of phleg- 
mon in general, or the signs of rheumatism or gout. Such is 
the error, into which all pathologists fall, who deny the exist- 
ence of inflammation, unless when the symptoms are so evident, 
that it would be folly to dispute them. It may be admitted, 
that in inflammatory fever, there is not precisely what is called 
erysipelas, phlegmon, rheumatism or gout. But in certain in- 
flammatory fevers, caused by insolation, or by a forced, or rapid, 
or long continued march, it is evident, that there is intense irri- 
tation, even inflammation, of the skin, the sub-cutaneous and 
inter-muscular cellular tissue, and the articulations; since the 
skin is red, hot, and painful, especially when touched; since there 
is a sensation of heat in the articulations, which are painful, es- 
pecially when the parts which form them are put in motion, 



INFLAMMATORY FEVERS. 81 

M. Broussais, forgetting that it is the part of the pathologist 
to seize the most fugitive shades of irritation, asserts that in in- 
flammatory fever there is no sign of inflammation of the brain, 
the chest, the peritoneum, the liver, the spleen, the kidneys, or 
the arteries: he is correct, if he refers to the signs of inflamma- 
tion ordinarily recognised by authors. But the irritation of the 
digestive mucous membrane has not exclusively the privilege of 
confining its development to the obscure degree, which suffices 
to determine the phenomena of inflammatory fever. The same 
authors, who have overlooked the slight shades of gastritis and 
enteritis, have likewise overlooked those of the phlegmasia, or, 
if the expression be preferred, of the irritations of the other vis- 
cera, and M. Broussais himself is chargeable with this oversight. 
The description of inflammatory fever, given by nosologists, 
is not very favourable to his opinion: for we there find few symp- 
toms, which can be referred to gastritis, or enteritis, while we 
observe very marked symptoms evidently attributable to irrita- 
tion of the encephalon, the uterus, the muscles and articulations. 
In vain might M. Broussais assert that this irritation, how ma- 
nifest soever it may be, is but the index of a latent gastric irri- 
tation : this would be to subordinate what is evident to what is 
to be demonstrated. We assert that nothing demonstrates that 
the inflammatory fever of authors is always a gastro-enteritis: 
1st, because there is not, in all inflammatory fevers, thirst, red- 
ness of the point and edges of the tongue, epigastric sensibility 
and pain, which are the unequivocal signs of gastritis; 2dly, be- 
cause anorexia does not constantly exist in this fever, and even 
if it always existed, it alone could prove nothing, for simple in- 
appetence is not an infallible sign of gastritis; 3dly, because the 
cephalalgia in synocha often exhibits other characters than those 
of the cephalalgia produced by inflammation of the stomach; 
4thly, because the contusive pains and the inaptitude for exer- 
cise in the locomotive muscles may depend on encephalitis as 
well as on gastritis. 

When redness of the edges and point of the tongue, a disgust 
for food, and thirst occur, there is undoubtedly gastritis; but it 
remains to be decided whether the irritation of the stomach is 
primitive or secondary. M. Broussais affirms too positively that 
encephalic irritation always determines that of the digestive vis- 

11 



82 PHYSIOLOGICAL PYRETOLOGY. 

cera. It is well known to all practitioners that gastric irritation 
very frequently gives rise to encephalic irritation. If it be im- 
portant in all diseases to know the organ primitively injured, it 
is no less useful to discover it in the case under consideration. 

In what manner can we resolve our doubts when a number of 
viscera appear to be irritated in inflammatory fever? By an at- 
tentive study of the organic predisposition of the subject, his 
idiosyncrasy, and the mode of action of the morbific causes, to 
which he has been subjected, as well as of his morbid predispo- 
sition, at the moment they acted upon him. In this manner we 
shall be enabled to decide what organ received the first mor- 
bific impression, to what organ it has been transmitted, and, 
finally, what organ has received and retained it. We shall know 
in this manner what is the painful mobile, (douleroux mobile,) 
to use the language of M. Broussais, which produces all the 
symptoms by its more or less extended influence over the orga- 
nism. The circumstances in which the subject has been placed, 
previous to the invasion of the disease, will indicate in some sort, 
the progress of the morbific action; the symptoms will indicate 
the part in which this action is fixed. 

We have just seen, that among the causes of inflammatory 
fever, some act particularly upon the brain, some stimulate the 
muscular system, and the articulations, some accelerate the ac- 
tion of the lungs, and that there are some, which actively irri- 
tate the stomach or the skin. 

These causes do not always confine their influence to the or- 
gans upon which they specially act; for example, a violent fit 
of grief may not affect the brain so violently as to throw it into 
a state of disease, while nevertheless it affects it sufficiently to 
give rise, through it, to a sympathetic gastritis. In this case the 
organic predominance, the peculiar morbid predisposition, final- 
ly, the nature and seat of the symptoms, w T hich are most intense, 
will be sufficient to enable us to recognise the organ, in which 
the morbific influence has definitively fixed itself: if it be neces- 
sary to discover the organ primitively affected, it is not less im- 
portant to know the organ which is most affected. 

In most of the inflammatory fevers, we find force, frequency, 
fulness, and quickness of pulse, and a halituous (halitueuse) heat 
of the skin. These symptoms, which indicate that the irritation 



INFLAMMATORY FEVERS. 83 

has been transmitted to the centre of the circulatory system, are 
generally more easily recognised, than those which indicate the 
organ or organs principally affected: they are the expression 
of what is denominated general reaction, and the result of the 
connexion which associates all the organs with the heart and ar- 
terial system. These are the symptoms which have given rise, 
sometimes, to the opinion that this system alone was affected in 
synocha, and at other times to the belief that there was a lesion 
of the whole economy in this disease. But the arterial system 
does not constitute the whole of the economy, and even when 
it is the first to manifest its morbid state, it would be wrong to 
conclude that it w r as the first affected, or it will be necessary to 
admit that peripneumony, when it is first announced by symp- 
toms of a lesion of the arterial system, is nothing else than sy- 
nocha. When the symptoms which denote irritation of* the 
heart and the arteries appear to exist alone, it is, at least most 
generally, because the point which has suffered, is not sufficient- 
ly affected to occasion very marked local symptoms, although suf- 
ficiently so, to excite the action of the heart. When these symp- 
toms cease promptly, before we are able to discover in what or- 
gan irritation commenced, as sometimes happens in ephemeral 
fever, we can have little reason to lament our ignorance on this 
point, since the disease is benign and its duration short. But 
when the local irritation arrives at a certain stage, it is impor- 
tant to recognise its seat, and this is easily accomplished. 

If the encephalon retain a large share of the irritative morbi- 
fic action, the eyes are red, tearful, and sparkling; the patient 
cannot bear the light; there is tensive pain over the whole extent 
of the cranium, or only along the sinuses, before and behind, 
and particularly at the temples; the temporal arteries beat with 
such force as to be audible to the patient; the face is red, or it 
becomes red and hot by sudden flushes, and there is tinnitus 
aurium; the ears are affected with a sense of fulness; the nose is 
dry, and its internal membrane more red than ordinary. The 
pulse is quick and full, and has but little frequency, the tongue is 
white, the appetite is gone, there is no thirst and no disgust for 
food. After three, four, five, or six days, these symptoms 
diminish; a nasal hemorrhage frequently supervenes. If the 
irritation continues, all the symptoms are exasperated, and the in- 



S 4 PHTSIOLOGICAI. PTRETOLOGY. 

teDff fnal families become troobled: bat in this case, in the medi- 
bngnage ::' (he present day, the disease is no longer syno-J 

;'•.-., :.;: ;. ;t:7::7 2:2x1: :'t~t:. ::. 7" Tie ;Tz:::zi ::::::■ 
7: ;;:.:;;^:i irec : z::i:::. i.ii :.: r = : zzizlzizs: ::.:.: zizj :.: 
b-e z::5:,:>ri. 7~.e iise-i** is in :::i::i:: ; :: .: re:;zr::;i 

T7-f iz^zz.zz.z^-.zz :: :..z :z\zziz~ : :" :7r ::;7:: : '. r 
;;.;-. :r7r ::.::.: i :: :... : . : : 1 : 5 - 1 Iz^zsTy ::' ±: :z:=7i 
5:.i:f. 2ni 1:: zizz iz-z'.:zzz.zz: : : :. :.:':::. : 7- ^: 7. .5 ::- 
Lz-zzizz. izz'lzs :.: :.'.". t :":'.'. : ~~ ::. s 5/. : : 7 5 :: >;-.:. ::/.;. 

P".e±:n. :: ::. ; ::i::. —.:/. :7e ::.:-.i:'.:: :.::.:.-. : :" t: ::5i r 
£.— :•$- her:: :t::.. ::: :: ir priz: . : ; '. zzz'zizs : :' -v..:/, ; : :: r :. : 5 
:: z<i ±e i.::-7i.ri7:z ::" z~e pz~5.iz:z : :' :..: Zr.ir:; :he 
<r-."'r.:-": : :' izii T.5.; :? :t .-. :.:ri:_5 zzz :r, 7:7: _ 
g >r Eoe be stomach; a ™id mental emotion, 

:z: ::t:: ::' —/..:::. .:. ::':i.:, :::.... 7 ::: :z- - :::5o= 2 



±c7 :::;::: r. :: 7:".- ; ;. z7..: .- .5-:. z7e ::z< 
z: \'..:.zzz, zz.zZz :s z: :z::5: zz.i z: izsz'is: :':::' 
v i — :r_: :: ::;:z:i. 7.: .5 5:. :e ; : ;;.:.-. : T f :zr* :~ 
Tz ::"""5. ::7rf5 j.;zit ::7rr :zz'zzz. Z'zS.izS ~.Zz '. 
:rr.:.i:ri ::: 5.:::: ;. — -.-.- - 7 ;_s :; ;. -_ :. -. /. T 5; ; . _ 
:;i: :: ;:..:.. A 57^7: _ -75 .;.;;.:.: ;:. ;:.::. :7" /....:.:." 



V. 



:: 



tzt r.-.i: 

Uz: -?..:■ 



INFLAMMATORY FEVERS. 85 

febrile symptoms, for he defined fever in the following manner, 
viz: an extreme heat developed in the heart, and extending 
thence over the whole body. 

When the irritating causes have exercised their influence in 
the first place on the stomach and intestines, or when they have 
extended their influence to these viscera, without involving 
other organs in the irritation; in one word, when the stomach 
and intestines are primarily or secondarily irritated, we observe 
intense thirst, a redness of the edges of the tongue, disgust for 
hot drinks, and for food, particularly of a rich kind, a sense of 
weight and pain at the epigastrium; at least, when pressure is 
made upon this part. To these local symptoms are joined the 
following sympathetic ones: a hard, quick and frequent pulse, a 
lancinating pain above the orbits about the frontal sinuses, con- 
tusive pains in the joints and in the limbs; a pungent heat and 
dryness of the skin. This state lasts from two to four days, or is 
prolonged till about the seventh day, unless some remedial 
measures are resorted to. A favourable termination is announced 
by a diminution of the symptoms, by a discharge of urine, a 
diarrhoea, a sweat, and sometimes by a nasal hemorrhage or the 
appearance of hemorrhoids in individuals who are subject to 
them. But more generally, from the third to the fourth day, 
we observe the supervention of the symptoms of gastric, ady- 
namic, or ataxic fever, which will be treated of in the following 
chapters, or those of gastritis as described by authors of the last age. 

When a slight bronchial irritation, or an inflammation of the 
lung of little intensity, gives rise to the symptoms common to 
all synochal fevers, we recognise the organ principally affected 
by the embarrassed respiration, the shortness of the inspirations, 
the sense of heat referred to the chest, and by the sudden and 
transient pains in the sides of this cavity — pains to which the 
patient pays but little attention, unless when questioned; and, 
finally, by the cough which recurs from time to time. The 
pulse is frequent, large, full, often soft, the skin presents a hali- 
tuous heat. A slight perspiration, or a copious sweat, announces 
the termination of the disease, which rarely persists longer than 
three or four days, without manifesting unequivocal symptoms 
of bronchitis, pneumonia, or pleurisy. 

Under the name of milk fever has been designated the ephe- 



86 PHYSIOLOGICAL PYRETOLOGY. 

meral synocha, which arises from irritation of the mammae, af- 
ter delivery, when these organs, stimulated sympathetically by 
the uterus, begin to secrete milk. The swelling of the mam- 
mse which become hard and sensible to the touch, the heat, op- 
pression, and even pain experienced in these parts, sufficiently 
indicate the organ, whose irritation excites the contraction of the 
heart, and gives rise to symptoms of synocha. Gastric irritation 
often accompanies that of the mamma?-, but it is generally of lit- 
tle intensity. 

Synocha, occasioned by irritation of the uterus, is character- 
ized by a sense ef weight in the lumbar region, whence the pain 
extends into the hypogastrium and the vagina: by a distressing 
weight about the uterine region; by pruritus in passing the urine; 
by rigors returning at intervals, and followed by a disagreeable 
sense of heat, which from the abdomen extends over the whole 
body? and particularly to the head; by a numbness of the thighs, 
and of the inferior extremities, which are sometimes painful, and 
by somnolency. To these symptoms are united a full and bounding 
pulse, the tongue often presents no change; there is no appetite, 
although there does not exist a disgust for food; there is little or 
no thirst; the skin is hot and moist. The menstrual discharge, 
or a metrorrhagy, more or less abundant, often a copious sweat, 
or a discharge of sedimentous urine, sometimes a nasal hemorrhage 
announces the termination of this state, which only continues 
six or seven days, and frequently terminates before the fourth. 
The symptoms sometimes assume an intensity, which prevents 
all mistake as to the existence of metritis. 

An irritation of the kidneys, or of the internal membrane of 
the bladder, may give rise to an inflammatory fever. We re- 
cognise the first by a sense of weight in the lumbar region, by 
repeated rigors, by the suppression or the scantiness of the 
urine, by the painful and repeated discharge of urine, which is 
voided in small quantities at first, but afterwards copiously, and 
sometimes carries with it calculi. The signs of the second are 
tensive pain in the hypogastrium. a continual desire to pass the 
urine, a painful and repeated discharge of it, which is passed in 
but small quantities. This last species of synocha terminates 
sometimes by the discharge of abundant mucosities by the ure- 
thra, and oftener by a copious sweat. 



INFLAMMATORY FEVERS. 87 

When the skin is more irritated than any of the other organs, 
it is hot and of a rosy colour; it appears swelled or raised by the 
subjacent cellular membrane; pressure occasions uneasiness, and 
even pain in it; it is at first dry and rough, and afterwards co- 
vered with an abundant and hot sweat; the patient experiences a 
disagreeable sense of tension, on the surface of the body, as 
well as in the head. The pulse is very quick and frequent; 
the urine is scanty in the commencement, and abundant when 
the skin returns to its normal condition. A diaphoresis gene- 
rally announces the termination of the disease. 

The inflammation, and the pain in the articulations, in the 
muscles, in the parts divided by any instrument of violence, or 
by a surgical instrument, sufficiently indicate the seat of the ir- 
ritation, which occasions the acceleration, the frequency, and 
quickness of pulse in the synocha, which accompanies con- 
tusions and wounds, or is occasioned by a forced march, a resi- 
dence in a damp or cold place, the influence of which is princi- 
pally felt by the synovial membranes, and the fibrous and muscu- 
lar tissues. 

The synocha produced in this manner, continues as long as 
these causes continue to act; it ceases with them, and may be 
prolonged several weeks. The irritation, may, also, by in- 
volving a number of organs, give rise to the phenomena of gas- 
tric and other fevers, as we shall show in treating of traumatic 
fever. 

It is deemed superfluous to point out, in this place, the signs 
which announce that an inflammatory fever is caused by oph- 
thalmia, laryngitis, otitis, hepatitis, splenitis, pericarditis, &c. 
It would be necessary to pass in review all the inflammations: 
there are some which it would be impossible to mistake at the 
first glance. Others, are too obscure to be distinguished before 
they have attained such a degree of intensity, that the disease 
loses the name of inflammatory fever, or they do not generally 
develop themselves but in conjunction with a more important ir- 
ritation. 

Where the conviction is thoroughly entertained of the neces- 
sity of discovering the organ whose irritation i3 the principal 
source of the symptoms, with a view to prevent the conversion, 
as they say, of the inflammatory fever into a more grave one 



88 PHYSIOLOGICAL PYRETOLOGY. 

or into a dangerous inflammation; in other words, to prevent the 
aggravation of the primitive inflammation, or its extension to se- 
veral important organs, nothing will be neglected that may con- 
duce to the success of this investigation; the difficulty of which 
is peculiarly great in the case of infants, owing to their incapaci- 
ty to describe their feelings. 

I have observed the symptoms of inflammatory fever in two 
infants at the breast, one of whom was suffering from otitis, and 
the other from cystitis. I did not recognise the first of these 
diseases, until after the discharge of a puriform matter from the 
external auditory passage. The painful and repeated discharge 
of urine induced me to suspect the second, all doubts of which 
were entirely removed on observing the little patient whom I 
attended with M. Regnault, pass by the urethra a false mem- 
brane, and a turbid whitish urine. The child affected with oti- 
tis, incessantly tossed his head on the pillow; and always endea- 
voured to lie on the affected side; but my attention was not 
drawn to this symptom until after the discharge from the ear. 
I had directed the application of leeches to the temples of this 
infant, considering the symptoms as derived from a cerebral ir- 
ritation. Leeches had been applied to the abdomen of the other, 
and he had been several times plunged into an emollient bath. 
They both recovered. 

Should it be remarked that I have just described the first ef- 
fects of encephalic, gastric, or bronchial irritation, and not in- 
flammatory fever, I should reply that no pyretologist would re- 
fuse to recognise the inflammatory fever in these cases of disease, 
which nature every day presents to our eyes; as could readily 
be demonstrated by a reference to the cases collected by P.- For- 
rest,* F. Hoffman,! Pinel,J and M. Recamier.§ M. Navieres 
states, that in 1802, there prevailed, during the autumn, an epi- 
demic inflammatory fever, in the commune of St. Martin des 
Champs, near Mantes. Whenever this disease attacked subjects 
of a bilious or phlegmatic temperament, or those, who being of 

* Observ. et Curat. Med. Paris, 1650, in 8vo. 
t Opera Omnia, Geneve, 1748, in folio, vol. il p, 106, 115. 
% Medicine Clinique, Paris, 1815, in 8vo. p. 19. 

§ F. Aygaleng, Dissertation sur Ua Fievre Angiotenique, Paris, an, viii. 
in 8vo. 



INFLAMMATORY FEVERS. 89 

a sanguine temperament, or suffering under the suppression of a 
hemorrhage, had been bled once or twice, the following symp- 
toms were observed, viz: headache, more or les3 acute, beating 
of the temporal arteries, tearful eyes, animated face, a moist 
tongue, white or red; general lassitude of the limbs, pain in the 
loins, an halituous or moderate heat, a pulse full, strong and 
well developed; red urine, insomnolence, no perceptible exacer- 
bation, cough without expectoration, deafness, diarrhoea with 
colic; from the fifth to the sixth day, no headache, but a heavi- 
ness of the head. 

The case was different in the instances in which blood-letting 
had not been practised; to the preceding symptoms were joined 
the following, from the tenth to the fifteenth day; face puffy 
and erysipelatous, pulse small and concentrated, moderate heat 
or a dry skin, slight delirium, drowsiness, dryness of the tongue, 
ardent thirst, complete deafness. One or two bleedings, prac- 
tised at this period, according to the constitution of the in- 
dividual, sometimes calmed the symptoms; but where the ir- 
ritation of the vascular system was extreme, either in conse- 
quence of the suppression of an habitual hemorrhage, or of inju- 
dicious treatment, (repeated purgation, wine, rich soups,) the 
disease assumed a third period, marked by the following symp- 
toms, viz: tongue covered with dry and grayish black scales; 
oppression, furious delirium, pulse small and concentrated, par- 
tial sweats, sometimes obstinate constipation, and meteorism; 
aphthae, face bloated and pale, a circumscribed redness of the 
cheeks, when there is a complication of pneumonia; the neck 
and one of the arms, very large, tense, shining, erysipelatous; 
paroxysm in the evening, during which the face was animated 
and the delirium still more furious. The patients asked for cider, 
apples, cheese, answered with propriety questions addressed to 
them, but in the most laconic manner: they frequently wandered 
from the subject, and it was necessary to repeat inquiries very 
often before an answer was obtained. 

In these cases the disease did not terminate until from the 
thirty-first to the thirty-seventh day. Sometimes, at the com- 
mencement of convalescence, there supervenes a phlegmasia, such 
as an inflammatory swelling of the side of the face, or a perip- 
neumony. This epidemic attacks indifferently all ages and sexes. 

12 



90 PHYSIOLOGICAL PYRETOLOGY. 

Of 554 inhabitants, 150 were affected. M. Navieres lost an in- 
fant two years of age on the thirteenth day, a boy of seven years 
on the thirteenth, a girl of nineteen on the sixtieth day, and a 
woman aged 57, on the fifty-second day. This disease had car- 
ried off from thirty to forty persons in the preceding years. He 
employed blood-letting from the commencement of the attack, 
when the subjects had suffered a suppression of an habitual he- 
morrhage; at the second period repeated blood-letting sometimes 
did not arrest the progress of the disease. The drink was acidu- 
lated barley water, sorrel water, veal or chicken water, infusion of 
mallows, nitrous whey, occasionally a light decoction of tama- 
rinds. Emollient lavements were prescribed. In the second and 
third period, any diluent nitrous emulsion, pediluvia, and wine 
and water at the termination. A single time, sinapisms and blis- 
ters were employed; it was in a case of suppressed diarrhoea; 
the chest and the brain were threatened; the patient lay for the 
space of half an hour without exhibiting any sign of life.* 

It is to be regretted that no post mortem examinations were 
made in the few cases of fatal termination. This account is ne- 
vertheless interesting, particularly in consequence of the care 
with which the author has marked, in the exposition of the 
symptoms, the influence of the treatment upon their appearance 
and their intensity. 

If from the general description of this epidemic we descend 
to the description of particular cases, to which we would refer 
the reader, the first presents us with an irritation of the bronchia, 
which in consequence of a purgative, extended to the stomach 
and intestines; the second, an irritation of the bronchia, of the 
stomach, and the arachnoid membrane; the third a gastro-bron- 
chial irritation; the fourth, a gastro-arachnoid irritation, and a 
fatal pneumonia; the fifth, a gastro-bronchial irritation; the sixth, 
a fatal gastro-enteritis; the seventh, an entero-bronchitis; the 
eighth, a similar irritation of greater intensity; the ninth, an 
enteritis; the tenth, an inflammation of the stomach, of the pe- 
ritoneum and the bronchia; finally, the eleventh an entero-bron- 
chitis. It must not be forgotten that this diagnosis is founded 
upon a statement of cases necessarily incomplete, since, at that 

* Dissertation sur une Epidemie de Fievres Inflammatoires, Paris, 1804, 
in 4to. 



INFLAMMATORY FEVERS. 91 

period, the obscure shades of these inflammations were not 
known; which probably occasioned many of their characteristic 
phenomena to be passed over unobserved. 

Were I to enter upon a detailed analysis of the cases collected 
by Hoffman, by Stoll, and by Pringle, it would be easy to de- 
monstrate that in every case there was a predominant irritation 
of one or more organs. Sometimes, says Pringle, we do not 
remark that one part is more affected than another; we only per- 
ceive some general symptoms of inflammation, and we then call 
the disease simply, inflammatory fever; although in these cases 
it is probable that some of the more indolent parts of the sys- 
tem are inflamed. 

The diverse irritations of little intensity, the phenomena of 
which I have been pointing out, are not always isolated. The 
irritation of the heart occurs in all inflammatory fevers, whatever 
may be the organ primitively irritated ; very often gastric irrita- 
tion coexists with it, and, in many cases, the irritation of the en- 
cephalon manifests itself at the same time. Then the fever 
presents the greatest number of symptoms, which have been 
assigned to it, as pathognomonic signs. The cardiac irritation 
gives no ground for apprehension, except as it may provoke, 
keep up, or increase the irritation of another organ; but even in 
this case, there is still an organ to which the physician must more 
particularly direct his attention, and it would be as dangerous as 
irrational, to combat only a general irritation, that is to say, blind- 
ly employ the antiphlogistic treatment. It remains for me 
to point out the relative frequency of the principal irritations 
which may give rise to the phenomena of these fevers. The 
digestive apparatus being most exposed to morbific causes, because 
of all the causes of disease, the most frequent are those which 
depend upon food and drink, and because most of the causes 
which act upon the skin, act sympathetically, by preference, 
upon the digestive mucous membrane, gastro-enteritis is most 
generally the proximate cause of inflammatory fever in adults. 
The case is not altogether the same with infants, and it is still 
less so with women. Among the first, the head is not less 
frequently affected than the stomach, perhaps it is even more 
frequently the seat of irritation. Among women, and particularly 
among young girls, the uterus is the organ most frequently af- 



92 PHYSIOLOGICAL PYRETOLOGY. 

fected. During adolescence, the chest is the part most liable to 
be affected. In young persons, who are devoted to the study 
of the sciences, which require exercise of the brain, and who are 
not exposed to the putrid miasms of anatomical rooms, the ence- 
phalon is the part from which the irritation is radiated. Among 
subjects who have an energetic heart and a well developed arterial 
system, the centre of the circulation is the principal point of irri- 
tation. In winter and in cold countries the mucous respiratory 
membrane is most frequently affected, and the digestive appara- 
tus during summer, and in countries which are dry and hot, 
hot and damp, or cold and damp. 

The inflammatory fever is endemic in dry and elevated coun- 
tries, and on the mountains exposed to cold winds. It is rarely 
epidemic, that is to say, the epidemic irritations seldom preserve 
that degree of mildness and obscurity, which prevents the dis- 
covery of the seat of the affection, and which occasions the atten- 
tion to be given only to the sympathetic symptoms, common to 
all the inflammatory fevers. When, however, these fevers are 
epidemic, they are most frequently occasioned by gastro-enteritis, 
bronchitis, or pneumonia, and are frequently observed to assume 
the adynamic character. 

The investigation of the seat of inflammatory fever is with 
propriety insisted upon, because it is the most important point 
of theoretical and practical medicine. I consider myself justified 
in laying it down as a principle, that this fever, such as authors 
have described it, is nothing but the first scene, if I may so ex- 
press it, of all the primitive or sympathetic irritations, attend- 
ed with symptoms of irritation of the heart. 

What shall we say of that species of uncertain, general disease 
spoken of by authors, which, after having menaced a diversity 
of points, at last fixes itself upon a single one? It is evident that- 
they have confounded a plethoric condition and sur-activity of 
the circulation, which predisposes to inflammation, with a posi- 
tively morbid condition, generally determined by a local cause 
of irritation, the action of which is favoured by the general con- 
dition of the economy. Besides, this predisposition is not so 
common as they pretend: most frequently it is the result of a 
local excitation, moderate, but yet sufficiently strong to give in- 
creased activity to the organic movement in a number of organs. 



INFLAMMATORY FEVERS. 93 

It is not my object to study what is called the termination of 
an inflammatory fever by a phlegmasia, or, in other words, the 
augmentation of the local irritation, which manifests itself finally 
by symptoms so intense, that they can no longer be mistaken. 
I shall only remark, that this conversion or termination is a pow- 
erful argument in favour of my opinion of the nature of inflam- 
matory fever, and against the opinion of JYL Broussais, and still 
more that of Pinel. The belief that the phlegmasiae might 
complicate inflammatory fever, or that the latter might be con- 
verted into a local inflammation, is derived from the fact, that 
in the synocha, occasioned by gastro-enteritis, or by any other 
irritation, obscured by the extreme intensity of the sympathetic 
phenomena, we sometimes observe the supervention of well 
characterized pneumonia, encephalitis, metritis, or arthritis; that 
is to say, that to the inflammation which is called fever, because 
its nature and seat are unknown, there is joined an inflammation 
which is called inflammation, because its seat and nature are 
known. 

Among the diverse terminations of inflammatory fever, (and 
the sense I attach to this expression is now known,) there are 
several which I shall consider in the following chapters; it is of 
these that the gastric fever, the adynamic, the ataxic, &c. have 
been made. 

Treatment of the Inflammatory Fever, 

From all that precedes, the following conclusions result: 

1st. The inflammatory fever is only a primitive or sympathe- 
tic irritation of one of the points of the digestive or respiratory 
mucous membrane; of the hair, the taterus, the skin, of a joint, 
of some point of the muscular system, of one or more parts of 
the body, influencing the heart, or, finally, of the heart itself. 

2dly. As this irritation often manifests itself by local symptoms 
little marked, he must study with great attention its causes, the 
idiosyncrasy of the subject, and the symptoms, to discover it in the 
midst of the sympathetic phenomena which it occasions. 

3dly. Many organs may be sufficiently irritated to attract al- 
most equally the attention of the physician. 

4thly. It is important to recognise the seat, more or less ex- 
tended, of the irritation which constitutes the inflammatory fever 



Q4 PHYSIOLOGICAL PYRETOLOGY. 

with the view of opposing its development, and preventing what 
is called the termination of this fever by an inflammation, by ano- 
ther fever, or its complications. 

5thly. In the treatment of this disease, regard must be had to 
the previous as well as the present condition of the patient, and 
the treatment, consequently, must be based on these two series of 
considerations; that is to say, that, to dissipate the local irritation 
which constitutes the inflammatory fever, it is necessary to direct 
our remedial measures especially against it, after we have com- 
batted the predisposition which has preceded it. 

Whatever be the seat of this irritation, the treatment consists 
in repose, abstinence, blood-letting, emollients internally and ex- 
ternally employed, and derivations of the least irritating charac- 
ter. If the inflammatory fever were a general irritation of the 
vessels, my task would terminate here ; at farthest, it would only 
be necessary to enter into some details, in relation to the great- 
er or less activity of the treatment, according to the intensity of 
the symptoms and the strength and age of the patient. But 
since the seat of the irritation varies, since each irritated organ 
affects the organism in a peculiar manner; since it is of impor- 
tance to ascertain the existence of encephalitis, angina, pneu- 
monia or gastritis, and since inflammatory fever may be occa- 
sioned by any of these, it becomes my duty to enter into details 
which formerly would have been superfluous. 

In the disease under consideration, there have existed pri- 
mitively an excessive alimentation and great activity of the sto- 
mach, the lungs, and the heart, or these conditions may not have 
existed. In the first case, whatever be the seat of irritation, a 
rigid diet and blood-letting are indicated. In the second, the diet 
may be less severe; and blood-letting may even be dispensed 
with in some cases in which the disease is of slight intensity. 
Blood-letting may likewise be dispensed with when the gastric 
mucous membrane is the seat of the principal irritation provided 
the cardiac irritation be not very intense. 

When blood-letting is indicated, it is not a matter of indiffe- 
rence whether it be taken from the neck, the arm or the foot; the 
seat of the irritation, if it be very intense, must decide this point. 
We must bleed from the arm when the lungs, the pleura 
the peritoneum, the liver and the uterus are menaced; when the 



INFLAMMATORY FEVERS. 95 

encephalon is the seat of irritation, blood must be taken from the 
jugular vein or the temporal artery, more frequently from the 
foot We must bleed copiously, and not fear to repeat the ope- 
ration, if the hardness of the pulse continue, if it be vibrating, and 
particularly if it become small without ceasing to be hard, for 
in that case, there is ground to fear that the heart may be se- 
verely affected. 

After venesection, or where it is not thought necessary to 
practise it, if the irritation be intense or prolonged, the applica- 
tion of leeches, as near as possible to the seat of the disease, is 
indicated. We should say that it is always indicated, if experi- 
ence did not prove that we may often omit it with impunity, 
and that we may do so in every synocha of slight intensity; for 
example, rest and diet are sufficient in that which arises from ir- 
ritation of the mammas, when these organs are about to secrete 
milk. However, there are more inconveniences to be apprehend- 
ed than advantages to be expected from the omission of blood- 
letting; and experience daily proves, that from the neglect of 
this curative measure, the inflammatory fever degenerates into 
inflammation, into gastric, adynamic, or ataxic fever. The me- 
thodical employment of leeches is never injurious; they may 
even be used to an improper extent, without any serious incon- 
venience, in inflammmatory fever. The abstraction of blood is 
very generally recommended in synocha; but venesection has 
been recommended in preference to leeching. Venesection is 
not so generally dreaded in this fever as in the others. Pinel 
himself recommends it. 

There are no fixed rules to determine the number of times ve- 
nesection and leeches are to be resorted to, or the quantity of 
blood to be abstracted each time, as this is entirely regulated by 
the idiosyncrasy of the patient, the intensity of the irritation and 
the nature of the affected organ. 

In general, one copious bleeding is sufficient; it is seldom the 
case that more than two are necessary, except in the case of men 
who have large lungs, an energetic heart, strongly developed 
muscles, an abundant and very stimulating blood; in the case of 
suppressed periodical hemorrhage, and in females who are suf- 
fering from suppression of the menses, or who have attained the 
period of their cessation, or who present the signs of plethora, 



96 PHYSIOLOGICAL PYRETOLOGY. 

often observed after the cessation of the menses. All these cir- 
cumstances may render it proper to bleed more than twice. — 

The quantity abstracted each time should not be less than 
twelve ounces; we may go as far as sixteen or twenty ounces, 
in the case of the individuals I have just mentioned, without 
exceeding this quantity; it is better to repeat the operation. In 
general it is preferable to produce, a sudden depletion by an 
abundant abstraction of blood, and, subsequently, to take each 
time a smaller quantity of blood, unless, which is so frequently 
the case, there occur suddenly an increased violence of the dis- 
ease, tending to become permanent, and threatening the life of 
the patient — in this case, we must not hesitate to have recourse 
to a bleeding equally copious with the first. 

We should especially repeat blood-letting, if the lungs are af- 
fected or only threatened: a fact which may be discovered by 
the embarrassed respiration, and the oppression, which is soon 
accompanied with pain. When carditis is suspected, the abstrac- 
tion of blood should neither be too copious, nor too frequently 
repeated. — The irritation of the lungs, as well as that of the pe- 
ritoneum, may require more than one bleeding, sometimes it is 
sufficient to resort immediately to the application of a large num- 
ber of leeches, and, as has been remarked, they should be pre- 
ferred to venesection, whenever the stomach is irritated. This 
organ and the small intestines being frequently affected, either 
primitively, or, at the same time, with the encephalon, the heart, 
the uterus or the lungs, the application of leeches to the abdo- 
men, and especially to the epigastric region, is one of the means 
to which we should most frequently resort in inflammatory fe- 
vers; and it is one of the measures that contribute most power- 
fully to prevent the degeneration of this fever into a fever of a 
bad character. 

But the application of leeches to the abdomen is not always 
sufficient to prevent the development of what is called cerebral 
fever. To obtain this result, we must, even when the state of 
the digestive organ is such as to require the application of leeches 
to the abdomen, apply them to the temples, behind the ear, or 
to the legs, with the view of preventing or combatting the pro- 
gress of the encephalic irritation; sometimes we must even re- 
sort to venesection, and practise it at the foot. — 



INFLAMMATORY FEVERS. 97 

The leeches should be applied to the sub-maxillary region, if 
there be angina; to the sternum or above this bone, or upon the 
trachea, when there is bronchitis, trachitis, or laryngitis; to the 
side of the chest, if there be pleurisy; to the precordial region, if 
the pericardium or heart are powerfully affected; to the right 
hypochondrium, in the case of hepatitis; to the anus, when the 
large intestines are irritated; to the perineum, to the hypogas- 
trium or the lumbar region, if the bladder or the kidneys are 
particularly irritated; to the vulva, the thighs or legs, when the 
irritation is seated in the uterus, and to the joints, when they are 
the seat of intense pain. 

In adults, less than eight or ten leeches should not be applied, 
and, this number being rarely sufficient, it is necessary to renew 
their application. It is often useful to commence with a greater 
number, fifteen, twenty, or even thirty, particularly if venesec- 
tion has not been resorted to previously. — The flow of blood 
should never be suddenly arrested on the removal of the leeches. 
Their bites determine an afflux of blood, which may be injuri- 
ous, in proportion to its vicinity to the irritated part. The 
blood, therefore, should be permitted to flow freely for one or 
two hours at least, after the removal of the leeches, and sometimes 
a much longer time, provided syncope does not occur, which 
is generally a favourable omen. The effect of this prolonged 
flow of blood is, that the afflux diminishes by degrees, that the 
irritated point loses a certain quantity of blood, and that the 
mass of this liquid is slowly diminished; we are thus enabled to 
abstract a greater quantity of blood without danger, by means 
of leeches, than by venesection, which produces a sudden de- 
pletion. 

The application of forty, fifty, sixty, eighty leeches, or even 
more, are rarely indicated, except in cases of peritonitis and 
pleurisy, where, at the commencement, venesection has not been 
practised, as should always be done, when the prompt abstrac- 
tion of a large quantity of blood is necessary; an indication which 
is fulfilled but imperfectly, even by the application of a great 
number of leeches. 

Were not this work particularly designed for the student, 
these details should not be insisted upon, but they are thought 
too important to pass over them in silence. The same motive 

13 



98 PHYSIOLOGICAL PYRETOLOGY. 

induces me to combat some prejudices, still very generally en- 
tertained, with regard to the effects of the application of leeches. 
This mode of abstracting blood weakens, it is said, and injures 
the organ of sight: leeches draw the blood towards the inflamed 
part and fix it there, when they are applied very near the seat 
of disease: in weakening the vital action of a part they may de- 
termine gangrene: they do not deplete so directly as phleboto- 
my, and have no advantage over it; their action differing m 
nothing from it, unless it be in this, that they have the inconve- 
nience of producing their effect more slowly: they occasion he- 
morrhoids when applied to the anus: they often occasion as 
many little phlegmons as there are bites, giving rise to an abun- 
dant secretion of pus over an extended portion of skin: finally, it 
is often very difficult, sometimes impossible, to arrest the flow of 
blood from the bites, and this hemorrhagy may occasion death. 

If all these remarks were well founded, it would certainly be- 
hoove us to renounce the employment of a means that would 
multiply so greatly the chances of failure. But this is far from 
being the case: depletion by leeches is, undoubtedly, of all active 
therapeutic means, the least capable of producing injurious ef- 
fects, even when abused. I do not think it necessary to answer 
those reproaches, which this method shares in common with the 
lancet. The question is simply this, must we have recourse to 
the abstraction of blood when it is indicated; the remarks which 
have been made upon the subject suffice to point out the cases in 
which leeches should be preferred to the lancet. 

The apprehension of weakening the sight is a popular error 
which I would pass by unnoticed, were it not entertained by 
some respectable practitioners. This prejudice has originated in 
the fact, that the sight has sometimes been observed to become 
weak, and even extinct, in a short time after the application of 
leeches around the orbits, to the anus, or to the legs, in cases of 
painful irritation of the eyes, and of obstinate and repeated in- 
ternal ophthalmia, which so often precedes alteration of struc- 
ture in the most important parts of this organ ; thus the aggrava- 
tion or appearance of a disease, which could not be cured or 
prevented, has been imputed to the employment of leeches. 

The afflux of blood to the irritated part, and the pain some- 
times increase after the application of leeches; this takes place 



INFLAMMATORY FEVERS. 99 

when in an intense inflammation, situated not far from the skin, 
a small number of leeches is applied, and especially when the 
blood is not permitted to flow after their application. This in- 
convenience is easily avoided, since it is sufficient not to be too 
reserved in the number of leeches employed, and to encourage 
the flow of blood after their removal. 

It has not yet been proved that the transition from inflamma- 
tion to gangrene may be the effect of the application of leeches: 
this is one of those groundless apprehensions, to which an ex- 
piring theory has given birth, and which experience contradicts. 
It is certainly improper in any case to abstract too much blood, 
but the opposite error is still more dangerous in its tendency. 

The slowness with which this mode of blood-letting acts, is 
one of its most precious advantages, where the use of the lancet 
might occasion a dangerous debility of the circulatory system^ 
or favour a fatal local congestion. 

The little phlegmons, occasioned by the bites, rarely occur 
when the leeches are well chosen; besides, these inflammatory 
tumours are an excellent derivative of the irritation which is to 
be combatted. Inflammation of the subcutaneous cellular tis- 
sue and the collection of pus which results from it, are a very 
rare effect of the application of leeches; they occur only on the 
abdomen, and always yield to proper treatment. This inflam- 
mation, which has appeared to me to contribute to the cure by 
the powerful revulsion it occasions, only manifests itself at the 
instant of the commencement of convalescence. 

It is absurd to dread the hemorrhage which may succeed 
the application of leeches, when it may be so easily remedied, 
by means of styptics, by cauterization, with the concentrated 
acids, the nitrate of silver cut to a sharp point, or a probe of 
copper brought to a white heat. When this accident is appre- 
hended, and the physician does not reside in the vicinity of the 
patient, in the country, for example, a small quantity of sul- 
phuric acid may be intrusted to some intelligent person among 
the friends of the patient, who is to be instructed in the manner 
of using it, in case syncope supervene before the flow of blood 
ceases. 

Scarified cups are to a certain extent a substitute for leeches, 
svhen these animais cannot be procured; but in this case it is ne- 



100 PHYSIOLOGICAL PYRETOLOGY. 

cessary to use the cup with pump and lancets described by 
MM. Sarlandiere* and Domours, or practise deep scarifications, 
and reapply the cup several times upon the same place, to 
abstract the necessary quantity of blood, to provoke a more con- 
siderable afflux, and an ecchymosis analogous to that occasioned 
by leeches. 

When, in inflammatory fever, the idiosyncrasy of the subject, 
the nature of the cause, and especially the symptoms, announce 
that the febrile movement is occasioned by gastro-enteritis, ab- 
stinence, which is indicated in every acute irritation, must be 
most rigidly enforced, even in the treatment of children and old 
persons. In every other case, it may be less severe: the broth 
of veal, chicken, or of frogs may even be allowed, care being 
taken to prohibit its use when the redness of the edges of the 
tongue announce the extension of the primitive irritation to the 
stomach. We must likewise enforce an absolute diet when 
there exists from the commencement of the disease a complication 
of gastro-enteritis with encephalitis. Experience alone can show 
how far it may be proper to depart from the severity of these 
principles under certain circumstances: it must not be forgotten, 
that if the irritation often terminates happily, it likewise frequent- 
ly happens that it increases, extends, and becomes complicated. 
The physician will then regret his compliance with the im- 
portunity of the patient and his attendants, or perhaps he will 
have to accuse the prejudices of his first medical education. 
I do not hesitate to confess, that I am here pointing out a rock 
upon which I have already so frequently split, that I consider it 
due to the interests of truth to make the avowal. 

It is only since the signs of gastric irritation have been point- 
ed out by M. Broussais, that it is possible to understand the 
importance attributed by Hippocrates to diet, according to the 
results of his experience. The admirers of the father of medi- 
cine, who very frequently pay little respect to his decisions, 
would do well to follow the precepts which he has given with 
regard to regimen, in the acute diseases, instead of setting them 
aside through the vain pretence that the moderns live less frugal- 
ly than the ancients. 

* Bdellometre, Paris, 1819. in 8vo. 



. INFLAMMATORY FEVERS. 101 

When the patient experiences no thirst, if the tongue be in its 
ordinary state, or if it be whitish, it will be sufficient to prescribe 
for his drink, water, either pure, or charged with a small quan- 
tity of mucilage, of gum Arabic, or of fecula, moderately sweet- 
ened with sugar or honey, taken in small quantities at a time, and 
repeated according to circumstances. If thirst be complained 
of, we recommend water acidulated with the juice of lemons, 
gooseberries, cherries, or with vinegar, or the drink may be 
orangeade, orgeat or clarified whey. All these drinks, taken at the 
temperament of the apartment, contribute to calm or prevent 
the irritation of the digestive organs; they replace without incon- 
venience the aliments which might excite, or aggravate this irri- 
tation, and they remedy constipation. This last symptom indi- 
cates the use of drinks, such as veal water, the decoction of 
prunes or tamarinds, of lavements of pure water, or of mucila- 
ginous lavements, or of those which are rendered laxative by the 
addition of honey, vinegar or some neutral salt. 

It is always useful to evacuate the fecal matters, which may 
have accumulated in the intestines. A remarkable melioration 
of the symptoms is always observed after this evacuation, which, 
however, we should be careful not to provoke by means of purga- 
tive potions or ptisans, which might occasion high irritation of 
the stomach and intestines. 

It is sometimes beneficial to solicit, gently, the secretion of 
urine by means of water, to which is added a small quantity of 
the nitrate of potash. But this drink does not produce the 
desired effect, and may add to the sympathetic phenomena of 
irritation, when it has its seat in the gastro-intestinal mucous 
membrane. The use of it is, on the other hand, eminently in- 
dicated, when the irritation is seated in the skin or in the liver. 
This salt should be administered in emulsions, with which 
however, camphor should not be incorporated, as it sometimes 
is, without good assignable reason. Potions with the oil of 
sweet almonds, at best useless, are positively injurious when 
there exists the slightest irritation of the stomach. 

Practitioners accustomed to permit maladies to pass undis- 
turbed through their periods, may deride the strictness of these 
precepts. Let us not, however, overlook the fact, that, in ar- 
resting the progress of what is denominated inflammatory fever, 



102 PHYSIOLOGICAL PYRETOLOGY. 

we very often prevent the development of maladies, always for- 
midable, and very frequently fatal. Besides, principles cannot 
be laid down too rigorously: — the careful application of them 
is unfortunately very rare. 

The employment of tonics in synocha, has hitherto been very 
injudiciously treated of, the precepts on this head have been con- 
fined to the vague recommendation of baths, semicupia, emol- 
lient fomentations, and refrigerant applications. Rubefacients 
and other derivatives have scarcely been mentioned. 

When the invasion of the disease has been preceded by signs 
of general plethora, we must not too promptly have recourse to 
tonics, of whatever kind they may be, as these applications may 
in certain cases be dangerous. The plethora must first be reme- 
died by general blood-letting. If the local irritation continue very 
intense, leeches should afterwards be applied to the part indicated 
by the seat of the disease, previously to the employment of de- 
rivatives. If the irritation be seated in the head, pediluvia of 
hot water, rendered slightly irritating by the addition of salt, 
vinegar, or ashes, should be prescribed in the morning, and es- 
pecially on the approach of night, with the view of preventing 
the exacerbations. Should the irritation persist, the feet should 
be plunged in very hot water, and kept in it for some minutes; 
leeches should then be applied above the ankles, and the feet 
again placed in water, not so hot as the first, and be permitted to 
remain in it from 10 to 30 minutes. The feet should then be 
taken out and enveloped in hot cloths, and the blood permitted 
to flow as long as it may be necessary. There are few cases in 
which this energetic mode of proceeding does not promptly 
cause the cessation of this afflux of blood towards the head. 
The application of ice-cold water, or of a cloth wet with cold 
vinegar to the forehead, powerfully seconds these remedial mea- 
sures. Irritation of the pharynx is advantageously treated by 
irritating pediluvia after blood-letting. Cataplasms, moderately 
hot, applied around the neck, are often useful. 

When the irritation is seated in the trachea or the chest, pe- 
diluvia are not indicated; it is sufficient to take blood from the 
parietes of the thorax or from the neck, to defend the patient 
from cold, to apply cataplasms to the neck or the sternum, and 
to prescribe mucilaginous drinks, or even sugar and water alone, 



INFLAMMATORY FEVERS. 103 

taken very hot, which is the very hest of sudorifics and expec- 
torants. 

I cannot here enter into the details of the treatment appropri- 
ate to laryngitis, simple or complicated, known under the name 
of croup,* or of many other inflammations of the neck and 
head; but I must repeat that the best manner of preventing or 
curing them is to resort to the antiphlogistic treatment, imme- 
diately on the appearance of the first phenomena of inflammato- 
ry fever. Pediluvia are not suitable in synocha produced by 
the irritation of one of the viscera of the abdomen unless it be 
the uterus. But the same rules apply in the latter case to that 
of the encephalon; to derive advantage from the pediluvia, the 
general and local plethora must first be combatted. 

In every irritation that occasions a remarkable acceleration of 
the action 'of the heart, energetic rubefacients, and still more ve- 
sicatory applications should be rejected. The mildest sinapisms, 
by inflaming the skin, add to the irritation of the heart. Vesi- 
catories increase that of the kidneys and the bladder. All these 
means are peculiarly dangerous when the redness and swelling 
of the skin announce that this tissue is more irritated than any 
of those which participate in the morbid condition. Even pe- 
diluvia are then contra-indicated; the internal use of emollients 
and refrigerants must be insisted upon, and the patient equally 
preserved from a sudden chilling of the skin and from too ele- 
vated a temperature. 

It is almost unnecessary to remark that emetics, purgatives, 
still more emeto-cathartics and stimulants, as well as tonics, are 
totally inadmissible in the treatment of inflammatory fever, what- 
ever may be the seat of the irritation constituting it, and that 
they are particularly dangerous in gastro-enteritis. Emetics, 
purgatives, and blisters, may be prescribed in the treatment of 
some inflammations, but they are improper in those which are 
announced by the symptoms of synocha. 

Beyond the Alps and in England, emetics and cathartics are 
ranked with the anti-phlogistic remedies, and recommended in the 

* See my articles Bronchitis and Croup, and all those which relate to in- 
ternal phlegmasia, in the Dictionnaire Abrege des Sciences Medicales, and 
my Nosographie Organique. Desruelles, Traite du Croup, Paris, 1824„ 

in 8vo. 



104 PHYSIOLOGICAL PYRETOLOGY. 

treatment of inflammatory fevers, because the evacuations which 
they produce occasion a prostration of muscular energy. These 
means certainly do debilitate, for they abstract materials from the 
economy, but at the same time they irritate the intestinal mucous 
membrane. Now, the irritation of this membrane often increases 
the intensity of the symptoms, much more than the abstraction 
of nutritive materials diminishes it. When the inflammatory 
fever results from gastro-enteritis, what must be the result of a 
practice so irrational? We must believe that this treatment, in 
some cases, occasions the cessation of the sympathetic phenomena, 
since it is affirmed by distinguished practitioners, but without 
doubt, the most frequent result is the inflammation of the gas- 
tric or intestinal mucous membrane, w r hich, although not an- 
nounced at first by signs easy to be recognised, yet sooner or 
later produces the most deplorable consequences. As every na- 
tion pays some tribute to error, we at least may felicitate our- 
selves that we have not to accuse ourselves upon this point: 
there are few errors so fraught with danger. 

The treatment of epidemic inflammatory fever, is the same as 
that of sporadic cases ; for the nature and seat of the disease is 
the same in both, except, that when we have treated a number of 
cases, we have an opportunity of determining from the com- 
mencement of the disease, what will be its principal seat, but 
we must not forget that this particularity depends more frequent- 
ly upon idiosyncrasy than upon the morbific cause. We should 
especially endeavour to prevent the degeneration of the inflam- 
matory fever, that is to say, we should prevent the local irrita- 
tion which constitutes it, from becoming exasperated and extend- 
ing to several important organs. It is then that we must not 
permit ourselves to be intimidated by the fear of the superven- 
tion of astheny, or as they say, of a fatal adynamy. 

Venesection, or the application of leeches, often relieves the 
profound prostration into which the patient has fallen, in conse- 
quence of the excessive irritation of the heart, which becomes 
painful and beats with difficulty. By diminishing the blood, 
and consequently moderating its stimulant action, the heart is 
acted upon precisely in the same manner as the stomach is in- 
fluenced by diet 

The treatment of M. Navieres in the epidemic of St Martin 



INFLAMMATORY FEVERS. 105 

des Champs, was as rational as it could be at that epoch; indeed, 
few practitioners would have evinced so much sagacity; for at 
that time, the debilitating effects of blood-letting were much 
dreaded. At the present day, by a more severe system of diet 
and by the employment of leeches, in addition to general blood- 
letting, we succeed in abridging greatly the duration of diseases 
of this kind. 

This violent irritation of the heart, more common in epide- 
mic inflammatory fever, than in sporadic synocha, never occurs 
but when the patients are abandoned to nature. Are there then 
cases in which it is proper to abandon them in this manner? 
Since we have pointed out what theory suggests and experience 
demonstrates, with regard to the treatment of synocha, the* so- 
lution of this problem becomes more easy. And, in the first place, 
what is meant by abandoning the disease to nature? Is it meant 
that the patient should continue to follow his occupations, that 
he should walk, work, eat and drink, and, in a word, act as in a 
state of health? Certainly, no one entertains such an idea of 
the method of expectation. The warmest partisans of this me- 
thod recommend repose, diet, the use of mucilaginous or aci- 
dulated drinks. It is then evident that all that is meant by this 
method is the exclusion of the abstraction of blood, except in 
some very rare cases. It is certain that many inflammatory fe- 
vers are cured, as I have already said, without the employment 
of any species of blood-letting; but the works of experienced 
observers are filled with examples of inflammations developed 
as a result of inflammatory fever: all authors agree that this fe- 
ver very often precedes the appearance of other fevers, particu- 
larly in epidemics. Now, admitting the supposition, which is 
contrary to every kind of probability, that the disease which 
succeeds the inflammatory fever, or which, to use their language, 
supervenes and complicates it, has no connexion with it, a sup- 
position which nothing justifies, which on the contrary every 
thing contradicts, still it cannot but be admitted, that in arresting 
inflammatory fevers at their commencement, by sanguineous 
emissions, the development of the secondary inflammation or 
fever, will, in the greatest number of cases, if not in all, be 
presented. This proposition is evident with regard to the tran- 
sition of synocha into manifest inflammation; the succeeding 

14 



106 PHYSIOLOGICAL PYRETOLOGY. 

part of this work will, I hope, prove that it is not less true with 
regard to the fevers which succeed inflammatory fever, or which 
complicate it Convalescence is always rapid after inflammato- 
ry fevers,, whatever be the organ principally irritated. When 
the pulse has resumed its normal condition, when the head is 
free and the skin without morbid heat, the subject mayimmedi-' 
ately return to his usual regimen, by gradually increased quan- 
tities. 

We would only recommend moderation in eating, even after 
the entire restoration of health, with the view of avoiding the 
renewal of the general plethora, which may have preceded the 
fever. He must avoid as much as possible a new exposure to the 
causes which have determined the invasion of the disease. He 
should particularly avoid returning too promptly to the use of 
wine, coffee and all drinks and aliments that actively excite the 
heart: moderate exercise in the open air, the use of light unstimu- 
Jating food, such as fruits and pot-herbs, not capable of occasion- 
ing flatulence, continence, and repose of the brain, will complete 
the cure. 

If after the disappearance of the symptoms which indicate the 
acceleration of the circulatory movements there remain pain of 
the head, a slight cough, an obstruction of the chest, some op- 
pression, palpitation, redness of the tongue, and a sense of 
weight at the epigastrium, or pain in the lumbar region, at the 
hypogastric or umbilical region, it is necessary, notwithstanding 
the return of the pulse to its primitive condition, not to permit 
the convalescent to satisfy his appetite before the disappearance 
of all traces of the morbid condition. A continuance of the 
means employed in the course of the disease, against the prin- 
cipal irritation, will hasten the progress of convalescence: these 
means, however, should be used less actively. 

It is easy to deduce, from what precedes, the rules to be ob- 
served with a view to the preservation from inflammatory fevers; 
and the avoidance of relapses, which, however, are not very 
common. 

V\ ith regard to the precept of giving tonics in convalescence 
from inflammatory fevers, it is sufficient to indicate the practice, 
to demonstrate its absurditv. 

I might here speak of the treatment of inflammatory fever, 



INFLAMMATORY FEVERS. 107 

complicated with an inflammation or another fever; but in 
treating of each of the fevers, which shall form the subject of 
the following chapters, I shall discuss their relations with the 
inflammatory fever. I think enough has been said to show, 
that when an inflammation appears to supervene upon an inflam- 
matory fever, there is an augmentation of the intensity of the 
disease, and not change of nature, or a complication, unless indeed 
the irritation, confined at first to a single organ, extend to one 
or more different organs, with such an intensity that it develops 
in the latter, a manifest inflammation. In both cases, the ener- 
getic employment of the antiphlogistic method, upon the dif- 
ferent points of the organism, which are inflamed, suffices to 
arrest the progress, extension, and repetition of the phlegmasia. 
We must not, under the vain pretext of avoiding protracted 
convalescence, hesitate to practise all the necessary vascular 
depletion; for before making the inquiry what will be the na- 
ture of the convalescence, we must do every thing that is neces- 
sary to bring the patient to this happy state. Protracted conva- 
lescence and prolonged debility are more frequently owing to 
the persistence of an irritation feebly combatted by a timid prac- 
titioner, than to diet and the loss of blood. 



PHYSIOLOGICAL PYBETfttafiT. 




CHAPTER TIL 



Fewer. 

Whe5 we compare the opinions of tte aacinls an 

moderns. ~ 
the Litter have 

pearance with those of lie anoeata, yet their ideas £&rnR 
than the words of their rea^eeliielaBgpagBa. HTf|WHJ iai lag»^ 
: tated bilious fevers by name, be has 
§es with heat and evacuation of bilious : 
first who divided continued fevers into sanguine and bilioasL I 
not imagine I shall be reproached 
distinction of the fever of one week, 
three weeks; but I should remark that 
considered the bilious fever only as a variety of the ardent fever. 
> 7 :ad then seen, notwithstanding his humoral thearyy *e 
analogy of bilious to inflammatory fever. This analog 
not but be observed, and it would not escape the 
tion of certain physicians of the present day. had Galen 
himself to a description of the symptoms, as Hi] 
instead of seeking notions with regard to the nature of the dis- 
7 7 in the alvine evacuations of the patient. 

Baillou was the first to give the name of gastric fever to the 
disease which Hoffman had named choleric fever, BagHvi the 
mesenteric fever. Pinel the meningq gutiwij and Hecamier the 
bilious pepsic fever: Baillou. disregarding the bilious symptoms. 
has not separated the gastric from the inflammatory fiever y but 
confounded them under the name of synocha. If dais union pos- 
some advantages, it is not exempt from inconvenience. 
For an accurate description of what might be denominated pure 
bilious fever , we must read the work3 of Stoll and Tissofc. Flake 
has described, under the name of anomalous bilious jewer r &- 




GASTRIC FEVER. 109 

verse morbid states which he attributed to the proximate cause of 
bilious fever. I. P. Frank has followed the footsteps of his 
predecessors. Pinel has only reproduced, in other terms, the 
humoral theories of the Galenists; giving the name of gastric 
embai^rassment to the state denominated by them turgescence 
of the bile, or bilious saburra. 

Let us here take a summary view of the descriptions given 
by all these authors. 

Bilious or gastric fevers are announced by the loss of taste 
and appetite, a repugnance to food, particularly to meats and 
rich soups; by the bitter taste and clamminess of the mouth, a 
white or yellow covering of the tongue, fetor of the breath, 
general lassitude, a painful sense of weight in the heart, the back, 
the loins, and the extremities, pallid complexion, the greenish 
yellow colour of the conjunctiva and of the part around the lips 
and the alas nasi. This state may continue from one day to 
a month or more. In this space of time other sj^mptoms gene- 
rally supervene. Thus, we observe, 

1st A sense of weight, of pulsation, and even of pain at the 
epigastrium; frequent and nidorous eructations, nausea and vo- 
miting of bilious matters, (gastric embarrassment.) 

2dly. Colics, borborygmi, tension, and swelling of the abdo- 
men, constipation, or a diarrhoea of matters of a greenish yellow 
colour, pains in the inferior extremities, particularly in the knees, 
{internal embarrassment.) 

3dly. These two series of symptoms frequently manifest 
themselves at the same time, (g astro-intestinal embarrass- 
ment. ) 

4thly. Often, after these phenomena have continued some 
days, one or more weeks, or even a month, a rigor occurs, the 
pulse is small and concentrated, the skin is dry and becomes the 
seat of a burning pungent heat; the pulse becomes frequent, full, 
and hard; the thirst, anorexia, disgust for food, and bitterness of 
the mouth augment; the patient desires cold and acidulated 
drinks; he experiences pain in the frontal region, a sense of las- 
situde and contusive pains in the back and in the limbs, which 
can no longer sustain him. Entirely occupied by these sensa- 
tions, he sometimes scarcely perceives the pain he at first felt at 
the epigastrium; but when the slightest pressure is made upon 



HO PHYSIOLOGICAL PYRETOLOGY. 

this part, he shows by his complaints, that the pain has not 
ceased. The tongue becomes dry and manifestly red at its 
edges, and at its point; it is more thickly coated; a yellowish 
tint more or less deep, is spread over the whole surface of the 
body. The patient, more irascible than usual, does not sleep, 
or his sleep is interrupted, and is not refreshing, (bilious fever.) 
Upon the morning succeeding the day upon which the rigor oc- 
curs, it reappears. It generally commences about the back, and 
is accompanied with trembling, the pulse becomes small and con- 
centrated; the dryness, the pungent heat of the skin, and the 
thirst increase, the face becomes red and animated; the pulse re- 
sumes its force and hardness, and after the lapse of half an hour, 
or one or more hours, the surface becomes moist without losing 
the character of pungency, which distinguishes it, and the pa- 
tient finds himself nearly in the same state in which he was be- 
fore the paroxysm, which, with more or less intensity, is re- 
peated under the quotidian, tertian, quartan, or double tertian 
type, and, sometimes, under an irregular type. There are 
sometimes only simple paroxysms, that is to say, exacerbations 
of the symptoms, without a return of the rigor and smallness of 
the pulse; it is then a continued fever: when the paroxysms are 
better characterized, it is remittent. In the first case, it gene- 
rally continues from seven to twenty-one days and upwards, if 
the treatment, generally recommended by authors, be resorted 
to; in the second, the duration is from fourteen to forty days. 

When this fever terminates favourably, the change is an- 
nounced by a general diaphoresis, warm and mild to the touch; 
dry urine depositing a rose-coloured or lateritious sediment, a 
diarrhoea, or vomiting of mucosities or bile. More frequently 
the symptoms amend gradually, without the occurrence of the 
evacuations, which have just been mentioned; but, in all cases, 
the skin becomes moist and pleasant to the touch; the urine flows 
more freely than before, and deposites a sediment more or less 
analogous to that which has just been mentioned. 

It is far from being the case that we always obtain the cure of 
bilious fever; frequently, (not occasionally, as Pinel says,) it 
passes, between the third and the seventh day, to the state of 
adynamic, ataxic, yellow fever, &c. ; or it becomes complicated 
with a manifest inflammation of the lungs, and frequently termi- 



GASTRIC FEVER. Ill 

nates fatally, if the usual treatment be employed. At other 
times, it assumes the intermittent type. Pinel has said of the bi- 
lious, as well as of the inflammatory fever, that it never terminates 
fatally, except in cases of complication, and that the prognosis 
is never unfavourable. His predecessors did not express them- 
selves thus, because none, equally with him, separated fevers 
from their precursory symptoms and their sequelae: it is, how- 
ever, certain that death does not occur, while none but the symp- 
toms assigned to gastric fever, by this professor, are observed. 

This fever is not always preceded by gastric or intestinal 
embarrassment; frequently it is preceded by no precursory sign. 
Sometimes it supervenes in the course of an inflammatory fever, 
in consequence of gastric irritation: in this case, there is only an 
increased intensity of the gastric symptoms, and of those of the ir- 
ritation of the heart; constituting the causus of the ancients, and 
the bilious or gastric inflammatory fever of the moderns. 
This fever may, like simple bilious fever, degenerate into an 
adynamic or ataxic fever, or become complicated with a decided 
inflammation; it very seldom passes into the intermittent type. 

5thly. After the symptoms of gastro-intestinal embarrass- 
ment have continued some days, the gastric sensibility some- 
times becomes an acute pain, lacerating and insupportable; the 
patient vomits, and at the same time passes by the anus, the debris 
of food, imperfectly digested, and bilious matter, of a greenish, 
grayish, or blackish colour, or resembling the lees of wine; he 
is affected with hickup, tenesmus, and a burning thirst; he suf- 
fers from a sense of burning heat in the abdomen, while his 
hands, and more especially his feet, remain cold; the surface ge- 
nerally is dry, while his head and chest are covered with a cold 
and clammy sweat; the epigastric region is tense, hot, and pain- 
ful, as well as all the anterior parts of the abdominal parietes; 
the face is shrivelled, the features are greatly altered, and ex- 
press suffering, the calves of the legs are affected with painful 
cramps, the patient throws himself across his bed upon his ab- 
domen, or remains motionless in the most complete prostration: 
frequently he is affected with delirium, and his limbs arc agi- 
tated by convulsive movements, [cholera.) 

The cholera is not always preceded by symptoms of gastro 



112 PHYSIOLOGICAL PYRETOLOGY. 

intestinal embarrassment: it is sometimes announced suddenly 
bv a violent rigor, coldness of skin, the smallness of the pulse, 
which continue during the development of the symptoms of the 
disease. After one or more hours, or in sis or seven days at 
farthest, the symptoms cease rather suddenly, or they assume 
increased intensity: the vomiting becomes more and more fre- 
quent, as well as the hickup and syncope: delirium supervenes, 
or augments: the convulsive movements are redoubled: if the pa- 
tient retain a consciousness of his existence, he complains of 
burning thirst, and intense pains, and, finally, falls into a stupor 
and expires. 

On opening the body, the mucous membrane of the colon, 
duodenum, and stomach, is found thickened, vividly red in 
some points, of a brownish red and sphacelated in other points; 
the alimentary canal is often wonderfully contracted: these cir- 
cumstances, according to the remark of BC Geoffroi, banish all 
doubt with regard to the inflammatory nature of cholera. 

M. Keraudren has published an account of the cholera morbus 
of India, in which he informs us, that post mortem examination 
displayed unequivocal traces of inflammation, when the fatal ter- 
mination did not occur too suddenly. BC Gravier has published 
observations establishing the same fact. 

The causes of these different affections are: adult a^e. old a°:e. 
the bilious temperament, debility, an excessive sensibility: a re- 
sidence in hot and damp climates, and in paludal districts, living 
in hospitals, prisons, ships, and camps: summer, particularly the 
termination of this season, and the commencement of autumn, 
excessive alimentation, the use of certain indigestable or irri- 
tating articles of food, such as black meats, fat, oil, beans, onions, 
pine-apples, poisonous mushrooms, the cold drinks taken during 
perspiration, alcoholic drinks, the sweet wines, very irritating 
medicines, emetics and cathartics of a very violent kind, or in- 
judiciously administered, acids, the antimonial and arsenical pre- 
parations, the presence of worms in the intestines or stomach: 
a sedentary life, or immoderate exercise, a transport of rage, the 
depressing moral affections, assiduous application to study, inso- 
lation, the suppression of the cutaneous transpiration, of the 
gout, the itch, the herpetic affections: finally, dentition. 



GASTRIC FEVER. 113 

Let me not be accused of having given at pleasure an inco- 
herent picture; I quote almost verbatim.* 

From the time of Galen, until the end of the last age, the 
production of the diseases of which I have just enumerated the 
symptoms and the remote causes, predisposing and occasional, 
have been attributed to the superabundance or the acrid quality 
of the bile, at first in the liver, and afterwards passing into the 
stomach and intestines. Cullen himself was not altogether free 
from this error, which was entertained, if not in its totality, at 
least to a great extent, by Tissot, Finke, Selle and Stoll. J. P. 
Frank vacillated between an obsolete theory and the truth, when 
Pinel declared against Brown, who attributed the bilious fever 
to debility, and against the other authors whom I have just men- 
tioned. In accordance with Fordyce, his language is as follows, 
viz: " Every thing seems to demonstrate that the principal 
seat of these fevers is in the alimentary canal, especially the sto- 
mach and duodenum, no less than in the organs secreting the 
bile and pancreatic juice. " But he sees in the disease only an 
augmentation of febrile irritability, and he admits a kind of oc- 
cult cause, which, he says, is at present, and doubtlessly will be 
long unknown. M. Tomasini endeavours to prove that bilious 
fevers, and other analogous affections, are only phlegmasia^ of 
the liver, which extend more or less to the stomach and intes- 
tines. This was a happy correction of the opinion of Galen, 
who, as I have just remarked, recognised the irritation of the 
primae viae. M. Broussais has gone farther, and has proved 
that the stomach is, in reality, the principal seat of bilious fevers. 

When we study with care the causes of these fevers, we per- 
ceive, that if some act primarily upon the brain, as wounds of 
the head, violent anger, depressing moral affections, prolonged 
study, watching; others act upon the skin, as insolation, the sud- 
den cooling of this tissue, and the disappearance of the phleg- 
masiae, of which it is the seat; or upon the articulations, as 
evinced by the sudden cessation of pain, affecting these parts, 
in consequence of exposure to cold; yet, that they direct their 
action, finally, towards the digestive canal, and especially the 
stomach, which is the most irritable part of it. For a more ob- 

* Nosogr. Phil., 5th ed. tome 1, p. 74, et suiv. 
15 



114 PHYSIOLOGICAL PYRETOLOGY. 

vious reason, these parts become irritated when their internal 
surface is placed in contact with food of too exciting a quality, 
stimulating drinks, irritating poisons, the agent designated by 
the name of miasms, exhalations, etc. 

The direct or sympathetic effect of these different causes is 
more powerful, when the subject has arrived at the period of 
life at which we observe the existence of gastro-hepatic predo- 
minance, indicated by the desire of stimulating food and drink, 
energy of digestion, habitual constipation, and the yellow tint of 
the skin, which characterizes the inhabitants of hot countries, 
and particularly of hot and damp climates. This predominance 
of the stomach and liver, which Bordeu well recognised, in- 
creases in summer, and particularly towards the decline of this 
season, when the heat, without ceasing to be intense, becomes 
united with humidity. The influence of this predominance con- 
tinues even during autumn, provided there be a continuance of 
heat, or the heats of summer have been excessive. To the usual 
signs of gastro-hepatic predominance are then joined prostration, 
fatigue, a sense of contusion in the limbs, and particularly in the 
articulations, precursory signs of the irritation which succeeds 
the active stimulation of the stomach. If the irritation be not 
very high, and be confined to the stomach, we observe the symp- 
toms which have been collectively designated under the name of 
gastric embarrassment. If the irritation be confined to the in- 
testines, we have intestinal embarrassment. When both these 
parts of the intestinal canal partake of the irritation, it consti- 
tutes gastro-intestinal embarrassment; if the irritation be- 
come aggravated, it gives rise to the phenomena of bilious or 
gastric fever. Finally, when the irritation supervenes sudden- 
ly, or becomes suddenly exasperated in the stomach, the duode- 
num or the colon, bile is abundantly evacuated upwards and 
downwards, and the abdomen is affected with violent pains: this 
constitutes cholera. 

There is one variety of gastric embarrassment, with which it 
is important to be acquainted. The tongue, covered with a foul 
and thick coating, is not red at its edges: the mouth is bitter and 
clammy; the appetite is nearly the same, or it is merely dimi- 
nished, there being no disgust for food: the excrements are a 
dirty gray or a deep gray, and not coloured with bile. This state 



GASTRIC FEVER. 115 

is sometimes coexistent with entire integrity of the stomach and 
intestines; the irritation exists only in the liver, or at most in 
the duodenum; the stomach is free from irritation. Yet, in old 
persons and in certain individuals, whom it is difficult to charac- 
terize, irritation of the stomach exists, although the edges of the 
tongue are not red, and there is neither thirst nor nausea; if, 
however, we press upon the epigastric region, we occasion pain. 

When the irritation is sufficiently intense and extensive, to 
give rise to a reaction of the heart, and constitute gastric or bi- 
lious fever, three series of symptoms result, one of which per- 
tains to the digestive apparatus and its connexions, one to the 
heart, and, finally, one to the encephalon. These different 
symptoms present themselves under four different shades, which 
I deem it necessary to point out with care, since they present 
special indications. 

The first shade is characterized by pain at the epigastrium, in- 
creased by pressure, redness of the point and edges of the tongue, 
dryness of this organ, the middle of which is covered with a 
slight coating, of a very faint yellow colour, by impaired appe- 
tite, thirst, a desire for cool acid drinks, which, notwithstand- 
ing sometimes increase the pain of the stomach, even when ad- 
ministered in small quantities; by nausea and the vomiting of 
mucosities without bile; frequency of the pulse, which is strong 
without being hard, burning heat of the skin, which presents 
no particular colour, with the exception of a deep redness of the 
face, which sometimes exists, a sense of painful weight in the 
frontal sinuses; finally, by constipation and scantiness of the 
urine, which is of a citron colour, or entirely colourless. This 
shade is certainly the one which decided Pinel to reject the name 
of bilious fever, and to substitute that of meningo-gastric fe- 
ver: it, in fact, presents none of the symptoms which are called 
bilious; the irritation is confined to the stomach and small intes- 
tine. There is in this fever a more intense degree of gastro-en- 
teritis than in the inflammatory fever occasioned by gastro-irri- 
tation; but the irritation is less intense than in the adynamic fe- 
ver, properly so called. 

The second shade is characterized by the following symptoms; 
viz. pain in the epigastrium and right hypochondrium, a thick 
and yellow coating of the middle of the tongue, which is dry, 



1 1 G PHYSIOLOGICAL PTBETOLOGT. 

while the edges and point are red, bitterness of the mou v. 
ten an mvincible repugnance to food, particularly to meat or 
rich soups; thirst, and a strong desire for add drinks, which 
are always taken with pleasure, and retained by the stomach, 
they are given in small quantities; a vomiting of bilioas 
a yellowish or greenish colour; frequency and extreme 
hardness of pulse; a pungent and burning heat of the skin, which, 
as well as the conjunctiva, is tinged with yellow over a part or 
the whole of its extent, acute pain in die forehead, the temples, 
and the base of the cranium; constipation, scarcity of urine, 
is thick and of a deep yellow colour. By these traits we 
the bilious synoekao£ the hnmoralists. and the bilious 
inflammatory fever of the pyretologists: it is an intense irrita- 
tion of the afam^hj which extends to the liver; in fact, one of 
±-= vir.^rf ::' pi :r :-::=-: r.::ii. 

The third shade has certain symptoms superadded to those 
of the preceding. To the coating and redness of the edges 
the tongue, which is often ve r y marked, and to the slight bit- 
terness of the mouth, are added pains about the umbilicus, a sort 
of painful bar extending from flank to flank, a diarrhoea of green 
or yellow bilious matters, often very abundant and fetid. The 
thirst is considerable, and the appetite is diminished: still the pa- 
tient has a vague desire for food, without being able to mention 
any particular article which he prefers; the sense of taste is 
less perverted than in the preceding variety; the epigastrium is 
less painful, and the thirst greater; there is no vomiting, the skin 
is not yellow; the urine is limpid, and the pulse more increased 
than in hardness. The irritation principally oc- 
intestines, and especially the colon; the liver is active- 
ly stimulated, and abundantly secretes bOe, which is poured into 
the duodenum, and passes thpnw into the rest of the intestinal 
tube: this is one of die varieties of entero-hepatitis. 

The fourth shade is announced by a union of the second 
and third symptoms; and if it s uperven e suddenly, with a high 
degree of violence, it constitutes cholera, the symptoms of which 
I have already described, If the morbid phenomena proceed 
with less rapidity, the disease presents the most complete pic- 
ture of all the bilious symptoms. In both cases it is to c 



GASTRIC FEVER. 117 

These shades of the bilious affections are not all equally fre- 
quent. That which is derived from gastritis, or from a simple gas- 
troenteritis, is ordinary. The shades, in which irritation of the 
liver is manifest, are epidemic, in years the summers of which 
are very hot, and particularly, when the season is at the same 
time hot and damp. They are endemic in countries, in which 
these two atmospheric conditions are united in a high degree; 
and particularly when the air is impregnated with marshy ex- 
halations, or any other deleterious gaseous matter. Particular 
kinds of food may render the occurrence of bilious epidemics 
very frequent, provided the seasons are at all favourable to their 
development. Such was the origin of the epidemic of Lausanne, 
described by Tissot;* of that of Teclemburgh, described by 
Finke;t and of that of Becetre, described by Pinel.f 

In most of the shades of gastric or bilious affections, we ob- 
serve symptoms which announce a sympathetic suffering of the 
encephalon; the pain is not always confined to the frontal sinuses: 
when it occupies the anterior region of the cranium, it cannot be 
doubted that the brain and its membranes are sympathetically 
irritated: hence proceed the headache, which is sometimes in- 
tolerable, an extreme sensibility of the organs of sight and hear- 
ing, and delirium, which if not well marked, is at least sufficient- 
ly so to render it impossible not to recognise at. These symp- 
toms announce a dangerous complication, the extension of the 
irritation to the encephalon. It is absurd not to pay attention to 
it, under the pretext that it is only a sympathetic phenomenon. 
It exacts a special treatment, if we wish to prevent the conver- 
sion of the bilious fever into the state of ataxic fever: cough, 
with yellowish expectorations, is also sometimes conjoined with 
the symptoms of bilious fever, especially when the hepatic irri- 
tation predominates. We should then examine with care the 
state of the chest, to be assured that respiration is not embar- 
rassed; that it exists equally on both sides of the thorax, that 
percussion produces a clear sound, and that inspiration is not 
painful; the stethescope should be employed with a view to 
guarding against inflammation of the pleura and the lungs. 

* Histoire Epidemise Biliosse. Lausaniensis, arm. 1755. 

f Des Maladies Bilieuses; trad, de Lugol. in 8vo, Paris, 1815. 

t Nosogr. Phil., tome 1. p. 60. 



118 PHYSIOLOGICAL PYRETOLOGY. 

It has been said that bilious affections may terminate by a diar- 
rhoea or by bilious vomiting: this is the same thing as asserting 
that bilious diseases cease when their symptoms have ceased. 
In the first shade of gastric fever, when the gastric irritation 
abates, the secretion of bile is sometimes suddenly re-established; 
this secretion, flowing into an organ still irritated, is expelled. 
If its presence has not exasperated the irritation of the stomach, 
this irritation continues to decrease, and it is then thought that 
the evacuation of the bile has determined the cure. The same 
thing occurs when the bile is poured into the intestines; if it 
does not prevent the diminution of the intestinal irritation, it 
is supposed to have contributed to the cure. It is difficult to un- 
derstand how the ancients reconciled this pretended utility of 
the bilious evacuation with their opinion of the acrimony of this 
fluid. All observers of reputation, and Finke himself, have 
avowed that bilious fevers may terminate without evacuations. 

The appearance of the urine is often changed towards the de- 
cline of these diseases. This fact is incontestable, but its import- 
ance has been magnified. We generally observe a lateritious 
sediment; it is of an orange colour when the liver has partici- 
pated in the irritation. A general and hot sweat often announces 
the restoration of the viscera to their normal condition. In gene- 
ral, an abatement of the pungency and heat of the skin and of the 
vomiting and diarrhoea, and a return of appetite are good omens. 
The most encouraging of all the favourable signs, in those shades 
of the disease, in which the stomach alone, or the stomach and 
liver, are affected, is the return of the tongue to its ordinary 
state. However, in the variety which I have attributed to entero- 
hepatitis, the tongue sometimes becomes clean and moist with- 
out a cessation of the morbid condition. 

With the exception of cholera, the prognosis in gastric or bi- 
lious diseases is never unfavourable as long as there are no other 
symptoms than those which have just been mentioned; at least 
it cannot be said that the bilious fever terminates fatally, since, 
whenever the symptoms become exasperated, and prostration, 
delirium, and other cerebral symptoms manifest themselves, the 
disease loses its name, and assumes that of grave bilious fever, 
adynamic m ataxic fever, the yellow fever, the plague, &c. 

Pathological anatomy then teaches nothjng directly with re- 



GASTRIC FEVER. 119 

gard to the nature and seat of gastric and intestinal embarrassment 
and of bilious fevers: I have, therefore, in all that has been said 
in reference to this point, only considered what we learn from 
the causes and symptoms. The remarks that shall be made 
with regard to the post mortem traces of gastro-adynamic and 
ataxic fevers may be applied to simple gastric fever, deducting 
what is due to the adynamic and ataxic symptoms. Yet the seat 
and nature of cholera, which is well known and is not disputed, 
except by a small number of physicians, and the analogy of the 
very intense symptoms of this disease, with the less intense 
symptoms of other bilious diseases, are proofs sufficiently strong 
in favour of our opinion of the identity of the morbid condi- 
tion in the bilious diseases, gastritis, hepatitis, and enteritis, 
admitted by nosologists. This truth, at the present day incon- 
testable, was undoubtedly known to Dehaen, who can only 
be reproached with the abuse of leeches. It redounds to the 
credit of this celebrated physician, that in recognising the in- 
flammatory character of the diseases which he treated, he evinced 
his superiority to Stoll, whose attention was occupied only 
with pretended disorders of the bile, and who attached too 
much importance to the aspect of the skin, the tongue, and the 
matters discharged by the mouth and anus, and too little to the 
results of autopsic examination. He appears still more inexcu- 
sable when we read the following passage: "It terminates fa- 
tally, 1st, by the metastasis of the bilious humour to an import- 
ant part of the economy, as the brain, the lungs, the cavities of 
the chest, of the pericardium, as we learn from dissections: 2dly, 
By an internal erysipelas, sometimes gangrenous; 3dly, By an- 
thrax of the intestines; by a putrid degeneration supervening spon- 
taneously, or in consequence of bad treatment." Nothing proves 
more strikingly how much the humoral theories fascinated the 
best observers and blinded their judgment. 

M. Rodet, veterinary surgeon, has published an interesting ar- 
ticle, viz: " Notice sur une Epizootie de Fievre Gastrigues Ob- 
servie a Rotten en 1814." He here demonstrates with certainty 
the existence of gastro-enteritis: unfortunately, none of the horses 
were opened during the course of the disease. How has it hap- 
pened, that no veterinary surgeon has yet conceived the idea, of 
resorting to vivisections, and thus resolving the most important 



120 PHYSIOLOGICAL PYRETOLOGY. 

question of practical medicine. This reproach bears only upon 
the professors of the schools of veterinary surgery, who alone 
can be expected to engage in expensiye experiments. The vi- 
yisection of diseased animals is one of the means which I haye 
pointed out in my Thesis " upon the classifications/' as capa- 
ble of contributing much towards the perfecting of pathology. 

AI. Bouillaud, has reported seyen cases of bilious or memin- 
go-gastric fever, in which, on dissection, he found injection, red- 
ness, thickening, softening, and friability of the gastrointesti- 
nal mucous membrane. He has reported also, the results of his 
experiments upon animals, with a yiew of determining a phleg- 
masia of this membrane.* The analogy of the symptoms ob- 
seryed in animals, and particularly of the organic alterations dis- 
coyered on dissection, with those observed in man, render these 
experiments yaluable. Researches of this kind should be en- 
couraged. 

Treatment of Gastric Fever. 

We find nothing upon indigestion, in our general treatises 
on medicine, and very little upon dyspepsia, to which nosolo- 
gists haye been content to assign a place among the neuroses of 
the stomach. The attentiye study, howeyer, of these two morbid 
conditions throws the strongest light upon the nature of gastric 
feyer. Has the name of indigestion been regarded as too tri- 
vial to find a place in scientific works? Is the term gastric em- 
barrassment more respectable? and would it be unworthy of the 
physician to employ the words of his vernacular tongue? 

Indigestion occurs when we introduce into a sound stomach 
an excessiye quantity of food, or food of a gross and irritating 
quality; and when into a stomach already irritated, we introduce, 
even in small quantities, food otherwise wholesome. In the first 
case, the presence of too great a quantity of food determines ir- 
ritation of the stomach, the digestive action of which exerts it- 
self in vain to alter the substances, which are subjected to its 
action. In the second case, this irritation is the effect of an irri- 
tating quality of the food. In the third case, the irritation of the 

* Traite Clinique et Experimental des Fievres dite essentielles, Paris, 1526. 
in 5vo, p. 86. 



GASTRIC FEVER. 121 

stomach augments under the influence of food, which, under 
other circumstances, would have been perfectly innoxious. In 
these three cases, then, there is primitive or consecutive irrita- 
tion of the stomach, and an imperfect alteration of the food, a 
state which is well designated by the word indigestion. We 
observe all the symptoms of well marked gastric irritation with 
coated tongue, bitter and clammy mouth, acrid, nidorous eruc- 
tations, particularly when the undigested aliments prolong their 
stay in the stomach. These aliments, imperfectly digested, are 
a powerful cause of irritation, which finally ceases to act upon 
this viscus, either in consequence of the expulsion of its contents 
by vomiting, occurring naturally or produced by art, or in con- 
sequence of their passing into the intestines, which they gene- 
rally irritate in such a manner as to produce acute colic pains, 
and all the phenomena of intestinal embarrassments. After the 
expulsion of these substances by the mouth or anus, we easily 
ascertain the fact of their imperfect digestion: they are often 
mixed with mucus or bile, even when the subject was in perfect 
health before the occurrence of indigestion. There then remain 
only the symptoms of simple gastric or gastro-intestinal irrita- 
tion; that is to say, the tongue becomes clean, although its edges 
are still red, the mouth ceases to be clammy and bitter, the ni- 
dorous eructation, the fetid gas, as also the disgust for food, dis- 
appear; but the distress, pain, and heat at the epigastrium, and 
around the navel, continue, as well as the vomiting and nausea, 
the diarrhoea and tenesmus, until, finally, all the symptoms gra- 
dually disappear. 

This is not always the case. When the heart and brain feel 
forcibly the influence of the gastric irritation, especially when 
the undigested food is not evacuated, and recourse is had to to- 
nics and pretended stomachics, the pulse becomes frequent and 
hard, small and concentrated, and sometimes continues so during 
the continuance of the disease; stupor, syncope, and convulsions 
sometimes occur, the extremities become cold, a cold sweat 
covers the body, and the epigastric region becomes hot and 
painful. 

In some persons of little irritability, indigestion produces only 
a disgust for food, a sense of weight in the stomach, a sort of 

16 



122 PHYSIOLOGICAL PYRETOLOGY. 

rumination, and few or no other symptoms of gastric irritation : 
the stools are unfrequent, gray or whitish, and without colic. 

In general, hot drinks sweetened with sugar and slightly aro- 
matic, are the best remedy for indigestion; the drinking of hot 
water, by provoking vomiting, and lavements of the same na- 
ture, are in general all that is necessary, but they must be fol- 
lowed up by cold drinks. 

These facts throw great light upon the treatment of gastric or 
bilious diseases: they show that all the symptoms of these diseases 
proceed from irritation of the stomach and intestines, that the 
presence of certain substances in these organs may provoke or 
keep up irritation ; that the evacuation of these matters is indi- 
cated, but that it does not suffice for the cure of the disease, 
which consists in a gastric, intestinal, or gastro-intestinal irrita- 
tion, involving the liver to a greater or less extent, that stimu- 
lants may increase this irritation, cause its extension to the brain, 
and render it dangerous; that in certain cases the only indication 
is to evacuate the contents of the intestinal canal, to cause the 
cessation of the indigestion. Furthermore, in numerous cases 
the administration of emetics, of too violent a character, is fol- 
lowed by the development of all the symptoms of the most in- 
tense gastric fever, with or without bilious symptoms. 

From the time of Hippocrates to the present day, the treat- 
ment of gastric affections has consisted in the expulsion, by eme- 
tics or cathartics, of the irritating matter which was always sup- 
posed to exist in the digestive passages. It was, however, 
perceived from time to time by attentive observers, that these 
evacuations did not always produce the good effect which was 
expected from them, and from this fact they drew the conclu- 
sion, that to derive all possible advantage from them, they must 
not be administered too soon, or be employed, except after having 
had recourse to certain means, capable of ensuring their efficacy. 
Hippocrates himself recommended to defer the evacuation of the 
morbific matter until it had been concocted. This principle is in 
opposition to his theory; for, if the fever be the effect of the 
crudity of this matter, why wait for its concoction, before ex- 
pelling it. Tissot has insisted upon the advantages of delayants; 
Stoll has pointed out the inconvenience of purgatives; Pinel has 



GASTRIC FEVER. 123 

followed them in these two points of doctrine, but, after the ex- 
ample of Stoll, he advises to commence with an emetic, or an 
emeto-cathartic, should there exist the slightest symptoms, or 
even a si?igte symptom of gastric embarrassment. 

Now, since, according to his theory, there are no gastric fe- 
vers without symptoms of embarrassment of the digestive pas- 
sages, since he places the signs of this embarrassment among 
the symptoms of these fevers; the consequence is, that we must 
always commence the treatment by the administration of an 
evacuant; and since the signs of gastric are more common than 
those of intestinal embarrassment, and since in most cases they 
accompany the latter, the result is, that an emetic is almost con- 
stantly indicated in the commencement of gastric fevers. In 
case of gastro-intestinal embarrassment, the emetic is still re- 
sorted to, since he here recommends an emeto-cathartic. This 
author has, it is true, spoken of bilious inflammatory fever, or 
ardent fever; but he has assigned the name of bilious inflammatory 
fever to one of little intensity, purely gastric, that is to say, one 
which presents no bilious or saburral symptom. That I may 
not be accused of imputing language to Pinel, which he has not 
used, I shall give in his own words, a passage which has, un- 
happily, been regarded as an axiom in practical medicine: "If 
this state of primae vise, (gastric embarrassment,) manifest it- 
self either in its simplicity, or in one of its diverse complica- 
tions, I employ an emetic, administered either with or without 
copious draughts of water: one or two of these symptoms well 
characterized are sufficient to determine me." 

This aphorism has produced incalculable evils: they have been 
pointed out by M. Broussais, who, in a clearer manner than any 
other writer, has shown the dangerous consequences resulting 
from the abuse of emetics. If, instead of employing himself in 
invectives against the partisans of antimony, Gui Patin had col- 
lected with care conclusive facts, the cause he advocated would 
have triumphed, and humanity have been spared many a groan. 

To keep principally in view the irritation of the stomach, the 
intestines and the liver, and to distinguish the cases, few in num- 
ber, in which recourse must be had to evacuants, is the funda- 
mental principle which should, at the present day, guide the 
practitioner in the treatment of gastric affections. 



124 PHYSIOLOGICAL PYRETOLOGY. 

When in a patient, we observe only redness of the edges and 
point of the tongue, a whiteness of the centre of this organ, 
anorexia, acid eructations, a marked aversion to wine, a sense of 
weight at the epigastrium, and no other symptoms, except weak- 
ness of the legs, it is easy to recognise irritation of the stomach, 
of the slightest grade. This slight degree of gastritis requires 
a rigorous diet, the use of cold mucilaginous or acidulated drinks, 
sweetened with sugar, or even the simple use of cool and pure 
water, according to the taste of the patient, and moderate exer- 
cise in the open air. 

If these symptoms augment in intensity, the tongue becomes 
dry, and the redness of the edges is brighter, red points appear 
in its middle, and are conspicuous amidst the whiteness of this 
part; the want of appetite becomes a real aversion to food, the 
epigastrium becomes painful, the skin hot, the pulse hard and 
frequent. The remedial measures which have just been pointed 
out, are no longer sufficient; we must add to them the applica- 
tion of leeches to the epigastrium, and of flannels or cloths 
steeped in a decoction of mucilaginous plants to the abdomen. 
Two or three leeches must be applied, in the case of infants at 
the breast; from three to eight, in children approaching the age of 
seven; and from ten to twelve, in adults. In every case the 
blood must be permitted to flow, after the fall of the leeches, as 
has already been observed, and for the reasons assigned in the 
preceding chapter. 

Thus far the most skilful nosologist might be defied to decide 
whether the fever be inflammatory, properly so called, or a gas- 
tric fever. To the physiological physician the problem is easily 
resolved: the disease is gastritis, and nothing must be neglected 
to prevent its becoming aggravated. 

When these means have not been employed, or when they 
have been found insufficient to arrest the progress of the disease, 
or, finally, when medical aid is not resorted to, until the disease 
has made a considerable progress, there is, in addition to the pre- 
ceding symptoms, vomiting, and all the phenomena which have 
been enumerated as characterizing gastric fever, without bilious 
symptoms; the highest degree of which is the ardent fevers of 
the ancients. Under these circumstances, the application of fif- 
teen, twenty, or thirty leeches must be made without delay, the 



GASTRIC FEVER. 125 

blood must be permitted to flow until we observe a meliora- 
tion sufficiently great to afford us hopes of a cure: the applica- 
tion must be renewed as the intensity of the disease and the 
force of the vascular system indicate the necessity. In general, 
it is better to establish an almost continual flow of blood by a 
small number of bites, twelve or sixteen, for example, than to 
renew the application of leeches; but we should not hesitate to 
repeat it, when the symptoms persist in all their violence. It is 
here that we have an opportunity of appreciating, at its true va- 
lue, the prognosis of gastric fevers, which, they say, is always fa- 
vourable, provided the disease be not converted into one of bad 
character: a proposition which signifies that the disease is not 
grave, as long as it has but little intensity. 

Acidulated drinks are sometimes too stimulating, unless the 
quantity of acid be very small, but, however mild they may be, 
they must be renounced the moment the patient complains of 
griping of the stomach, after taking them. Vinegar and water 
is almost always hurtful; lemonade is generally useful, and 
orangeade still more so in most cases; gooseberry-water may be 
substituted for it, although it does not agree so well with most 
stomachs; the decoction of cherries, and other ascescent fruits 
may be used with advantage; whey is often very suitable. 

Mucilaginous drinks sometimes disagree with the stomach, 
not because they occasion great irritation, but because they pro- 
duce a sense of weight in it, and render the mouth clammy. A 
slight decoction of mallows, of dog-grass, or even barley water, 
although the latter is improper when it is too thick, are often 
preferable to gum arabic. The same remark applies likewise to 
a decoction of the crumbs of bread. 

Pure water, which so few patients drink willingly, on ac- 
count of their prejudices, is in a great number of cases the best 
of all drinks. But it is frequently necessary to add to it a little 
sugar or liquorice. Hecquet has justly extolled the use of water 
in gastric affections;* in this he agrees with Hippocrates, Galen, 
and Celsus. 

The quantity and the temperature of the drinks is not a mat- 
ter of indifference. If the patient has little thirst, he must not 

* De la Digestion. Paris, 1747. 



121 PHYSIOLOGICAL PYEETOLOGY. 

be obliged to drink much, but he must not be permitted to re- 
main a long time without drinking. If the thirst be urgent, 
we may prescribe as much as two pints of liquid, but he must be 
advised to drink but little at a time. This precaution must be 
rijridly nbflerFedj particularly when there is vomiting 
quently but a spoonful of liquid must be given at a time, and 
that only at distant intervals. In all cases, nothing must be ne- 
glected to discover the drink which produces the least irritation 
of the stomach, and the idiosyncrasy of the patient must al- 
5 be regarded. 

The drinks should generally be given cold: but they should be 
hot, if there are rigors. In general, it is proper on this point to 
consult the taste of the patient, who is ordinarily the best judge. 
In case of obstinate vomiting, if we are desirous of arresting it, 
we must prescribe cold drinks — if to promote it, warm drinks. 
There are eertain shades of gastric irritation which require the> 
administration of very hot drinks: perhaps idiosyncrasy has much 
to do with the existence of these varieties. 

If I have said that we must prescribe an absolute diet, even 
when the irritation is slight, it is because diet is the most ef- 
ficient remedy for this disease in all its degrees: a means which 
in many cases entirely iianpates it, and the omission of which 
often renders all other means unavailing. Not only must we 
forbid the use of meats and all rich food, as all authors recom- 
mend in the treatment of g precept which may almost 
be considered idle, since the first symptom of the disease is a re- 
pugnance to food, particularly of this character; but we must 
likewise proscribe both, which patients are often compelled to 
take against their will, or which they call for, notwithstanding 
their aversion, in the hope that it will strengthen them. M. 
Broussais has not gone too far in asserting that the lightest broths 
may occasion fatal relapses. This is one of those practical truths 
that cannot be too generally inculcated, but which will be r 
ed for a long time, on account of the aversion of patients to an 
absolute diet, and the less excusable prejudices of the physician. 

A slight decoction of sorrel is beneficial, when acidulous drinks 
are supported by the stomach : it may be substituted for them in 
most cases, but we must not add to them either butter or salt. 

Simple emu^ ently prepared, and orgeat, when there 



GASTRIC FEVER. 127 

is much heat of the skin, water charged with a small quantity of 
carbonic acid, when there is nausea, may be prescribed, provided 
the irritability of the stomach be not very marked. 

The minute details which I have given, are necessary: many 
of a similar character will be found in the course of this work, 
since it is necessary to attend to them to prevent the aggravation 
of diseases, and their fatal termination. With many of these 
details physicians are acquainted; there are others to which 
they unfortunately attach too little importance. Of some among 
these principles, many physicians are ignorant: it is important 
that the student be not left in ignorance with regard to any of 
them, since they constitute valuable elements of success. 

I know, and the remark is intended for the physician as well 
as for the patient, I know that we may sometimes deviate from 
the narrow path pointed out by experience; but in this case 
the disease is of longer continuance, than when a more severe 
regimen is observed. It is much more common to see it, un- 
der these circumstances, become aggravated, extend to a num- 
ber of organs, attain a high degree of intensity, and often oc- 
casion the death of the patient, who has not obeyed his physi- 
cian, or who, through the inattention of his physician, has not 
been preserved from the influence of the causes capable of ag- 
gravating his disease. It is here that a proper opportunity of- 
fers to enforce the necessity of absolute diet, because it is par- 
ticularly indicated in gastric fevers: the remarks that have been 
made upon this subject are, throughout, applicable to the treat- 
ment of the diverse shades of gastritis, which shall be treated of 
in the following chapters. 

Nourishment should not be allowed until the pulse has lost 
its frequency, and the skin its heat. 

Emollient fomentations are very useful ; they should be resorted 
to, whenever there is much heat at the epigastrium: they have 
also the advantage of keeping up the flow of blood after the 
fall of the leeches. But, to be productive of good effects, they 
should be preserved, if not at a very elevated temperature, at least 
at such a degree of heat, that the patient may experience no sen- 
sation of cold, when the cloths are renewed, or while they are in 
contact with the skin; emollient fomentations maybe substituted 



128 PHYSIOLOGICAL PYRETOLOGY. 

for baths, to which we cannot hare recourse when the circula- 
tion is accelerated and the head painful. 

The constipation which attends gastric irritation, is not a for- 
midable symptom; but since it is demonstrated that the delay 
of fecal matter in the intestines, occasions headache and heat of 
the skin, it is proper to prescrible lavements of water, which 
may be either pure or mucilaginous, or acidulated, or mixed 
with oil or with honey. 

The pain in the head, which so frequently accompanies gas- 
tric irritation, generally disappears with it, when our remedial 
attempts are successful. But if the headache be intense, and pre- 
dominate over the other symptoms, pediluvia, cold applications 
to the forehead and leeches to the temples, are indicated, just as 
though there were no gastric irritation: for it is of importance 
to prevent the development of arachnoiditis, which is to be feared 
from the fixed character and intensity of the pain and its confine- 
ment to the frontal region. I shall again discuss this point, when 
upon the subject of ataxic fever. 

Such are the only therapeutic means to which we should have 
recourse in gastric irritations, with or without the phenomena of 
reaction of the heart, and without bilious symptoms. This 
treatment is not less suitable in intestinal irritation and in those 
cases in which both the stomach and bowels are involved. 

When to the signs of gastric irritation with or without febrile 
symptoms, are superadded those which announce that the irri- 
tation is shared by the secretory apparatus of the bile, we must 
in the first place have recourse to the same means; then all the 
symptoms diminish gradually in intensity, or those of gastric ir- 
ritation diminish, while the bilious symptoms continue, or final- 
ly the latter cease while the former continue. In the last case 
we must insist upon the means which have been pointed out. 
In the former we must continue to employ them as though the 
irritation were confined to the stomach; in the second we must 
have recourse to leeches applied to the right hypochondrium or 
anus, persevere in the use of acidulated drinks and prescribe the 
warm bath. When no pain is perceived in the hypochondrium, 
even when strong pressure is made upon this region, when there 
is no uneasy sense of pain and numbness extending thence to the 
right shoulder, when the skin does not change its colour, when 






GASTRIC FEVER. 129 

the urine is not of a deep yellow and the excrements of a whi- 
tish gray, when the tongue is uniformly and thickly coated, 
when there is no thirst, and no pain at the epigastrium even 
when strong pressure is made, no heat of the skin and no ac- 
celeration or hardness of the pulse, we may prescribe an emetic, 
provided the disgust, the bitterness of the mouth, and the other 
symptoms do not yield to the means which have been advised. 

Wherever there is heat of the skin, acceleration of the pulse, 
and redness of the tongue, emetics are contra-indicated; nor, to 
render their employment improper, is it necessary that the pulse 
should be hard and the tongue dry and cracked; consequently, 
in every gastric fever, properly so called, whether it be ardent 
or the ordinary fever of our country, and especially in the bi- 
lious fevers of hot countries, an emetic should never be adminis- 
tered. It can never be prescribed with impunity until after the 
cessation, not only of the febrile symptoms, but likewise of the 
symptoms peculiar to gastric irritation. When the latter symp- 
toms are not exasperated by the exhibition of the emetic, those 
of the biliary apparatus frequently are, and thus the fever is ex- 
asperated, and becomes more formidable. 

It would not be rational to prescribe an emetic in all cases of 
gastric embarrassment, unattended by signs of irritation of the 
stomach. There are no candid practitioners who do not acknow- 
ledge, that, to their great surprise, they have often seen this 
state grow worse, even after the emetic had produced the desired 
effect of causing abundant evacuations of bile. What succeeds 
best, in conjunction with acidulated drinks largely administered, 
are laxatives, such as the supertartrate of pot-ash, and lavements 
containing a small dose of the sulphate of soda or of magnesia. 
These evacuants have none of the inconveniences of emetics, 
provided the intestines are not irritated; for, in this latter case, 
they increase the heat and dryness of the skin, the uneasiness 
and thirst. 

When we prescribe an emetic, tartarised antimony is to be 
preferred, because the action of this medicine is sure and its ef- 
fects well known. But it must always be administered with 
caution, and never in a dose of three grains at the commence- 
ment, as is sometimes done; much less should this dose be thrice 
repeated. Its combination with ipecacuanha is always irrational. 

17 



130 PHYSIOLOGICAL PYRETOLOGY. 

It is especially at the commencement of gastric fevers, and 
during the existence of the state denominated gastric embar- 
rassment, that an emetic has been prescribed. It has been as- 
serted that it dissipates this embarrassment, the duration of which 
is sometimes so protracted, and that it unmasks the gastric fever, 
which succeeds it; that, administered in the course of this fever, 
it simplifies it, and in general produces a salutary shock. Let 
us examine whether all these advantages are to be expected. 

An emetic does not put an end to all cases of gastric embar- 
rassment, since it so often happens that the fever declares itself 
after their exhibition. It is not in reality advantageous, except 
in the case of persons subject to bilious diarrhoea, of short con- 
tinuance; of those who have contracted the habit of taking an 
emetic at certain periods of the year; of those who eat vora- 
ciously of gross and stimulating articles of food; of corpulent and 
pale persons of lax fibre and of little irritability; in cold and 
damp climates, and in northern countries. In this manner is to 
be explained the success of Stoll, Finke, and many other physi- 
cians, who practised in countries, the inhabitants of which, en- 
dowed with little sensibility, make use of an indigestible diet, 
and are addicted to excesses. 

When the gastric fever develops itself in the train of gastric 
embarrassment, after the exhibition of an emetic, that is to say, 
when, after its administration, the skin becomes dry, hot, and 
pungent to the touch; the pulse frequent, quick, and hard; the 
thirst intense, the mouth dry and the tongue red at its edges, is 
it not evident, that, instead of having unmasked the fever, the 
emetic has determined it, by exasperating the gastric irritation, 
even when it has dissipated the bilious symptoms? Now, the 
advantage which the patient derives from the disappearance of 
these symptoms, which are generally secondary, is more than 
counterbalanced by the augmentation of the principal irritation. 
It is, moreover, far from being the case that the bilious symptoms 
always yield to an emetic, particularly when the phenomena, 
which I have just enumerated, develop themselves, or assume 
increased intensity. More frequently, as I have already said, 
all the gastric, hepatic, and sympathetic symptoms become exas- 
perated. Nothing less than blindness of the grossest kind would 



GASTRIC FEVER. 131 

behold in this exacerbation of the disease only a salutary effect of 
the remedial measure resorted to. 

Stoll has strongly recommended emetics in the course of bi- 
lious fevers; but he would have the patient prepared for their 
exhibition, by bleeding, the antiphlogistic regimen, and diluents, 
when the patient is young or in the vigour of life, of rigid fibre 
or plethora, when inflammations are prevalent, and finally, when 
a heating regimen and stimulating medicines have been used. 
Doubtless he would have unhesitatingly rejected the idea of sim- 
plifying these fevers, by the premature administration of evacu- 
ants. If this celebrated partisan of emetics thought it necessary 
to have recourse to preparatory means, is it not absurd to reject 
these means, at the present day as at least useless, and to pretend 
that this preparation is attended with the inconvenience of occa- 
sioning the loss of a precious period, and of retarding the cure. 

It is only after the administration of acidulated, mucilaginous, 
and refrigerant drinks, that an emetic can be prescribed with ad- 
vantage: under these circumstances, alone, it simplifies the dis- 
ease by provoking the secretory action which must succeed the 
dry irritation of the gastric membrane. To render this measure 
innocent in the first stage of the irritation, it is necessary that the 
latter be slight. Nothing justifies, I repeat it, the administration 
of an emetic, when, from the commencement of the disease, the 
skin is acrid and hot, the pulse frequent and hard, the tongue dry 
and the thirst intense. When we are called to a patient, to whom 
at the commencement or at any other period of the fever, an 
emetic has been prescribed, we should entirely discard the idea 
of a pretended simplification, and have immediate recourse to local 
antiphlogistic means, should there be the least increase of inten- 
sity in the gastric symptoms, or any reason to apprehend it, 
whether the bilious symptoms have disappeared or whether they 
persist with the signs of gastric irritation. 

What is meant by the favourable shock occasioned by the 
emetic? Does it indicate the abundant transpiration which this 
medicine determines, and the afflux towards the head, so often 
dangerous, which it occasions? or, is the expression used to de- 
signate a special and unknown action? This last hypothesis me- 
rits no consideration. As to the sur-excitation, more or less 
permanent, of the skin, determined by the action of this thera- 



132 



PHYSIOLOGICAL PYRETOLOGY. 



peutic agent, there is an important distinction to be observed, 
which has not yet been made with sufficient care. The sur-ex- 
citation of the skin and the perspiration always occur during vo- 
miting; but the melioration of the state of the stomach, the in- 
testines, and the liver, follows it only in a very limited number 
of cases. It is not, then, to these sympathetic phenomena, pure- 
ly secondary, that we should attribute the diminution of the ir- 
ritation of the digestive passages, when we are so fortunate as to 
obtain it. This opinion would be equally erroneous with that 
of those authors who attribute the cure of fever to the profuse 
perspiration observed at the decline of many febrile diseases. 

It is proper to remark, that emetics sometimes procure a 
marked melioration during some hours, or for the space of one 
or more days, but that, after this period has elapsed, we observe 
a renewal of all the symptoms, provided the subject be at all dis- 
posed to gastro-enteritis. How great is the imprudence of those 
physicians, who, notwithstanding the return of the symptoms, 
repeat the administration of this medicine! In vain they cite 
certain cases in which they have triumphed over the malady, by 
means of a second, or even a third emetic. Like most of the 
rare cases of the successful employment of therapeutic agents, 
those instances have been productive of the most unhappy re- 
sults to humanity, because they have induced practitioners to 
prescribe emetics, in a number of circumstances, in which they 
are deleterious. From not comparing attentively the few in- 
stances of success with the numerous failures, they constantly do 
harm, without the probability of ever being useful. 

M. Chaufford is of opinion, that emetics may prove useful 
when administered four or five days after the entire cessation of 
the fever, when the head is altogether free from any affection, 
the tongue remaining saburral and the appetite languishing. He 
administers, in such cases, twenty grains of ipecacuanha; the 
patient should drink copiously; this dose is sufficient in most 
cases without resorting to purgatives. * 

Cathartics may be less injurious than emetics, because the lat- 
ter often extend their action, not only to the stomach, but also 
to the intestines, while the former irritate the mucous membrane 
of the intestines alone, the irritation of which is usually of short 



* Traite sur \es Fievres, Paris, 1825. 



GASTRIC FEVER. 133 

duration. But, like emetics, they exalt the intensity of the 
symptoms, by exasperating the gastro-intestinal irritation, when- 
ever they are administered at the commencement or during the 
course of the gastric fever. They cannot be given with impu- 
nity, except at the decline of gastro-intestinal irritation, and only 
in a small number of cases, analogous to those which admit of 
the employment of emetics. They should be preferred to the 
latter in old men and in persons who have contracted the habit 
of purging themselves every year at certain periods. 

It would be superfluous to demonstrate the absurdity of the 
advice given by the partisans of the humoral pathology to purge 
on alternate days; but I cannot pass over in silence the dangers 
of the combination of an emetic and cathartic. If when admi- 
tered singly each of these two measures is rarely useful, ordinarily 
dangerous, often fatal, what will be the result of combined ac- 
tion! Perhaps the danger of an emetic would not be so great 
but on account of its frequently extending, as I have just re- 
marked, its irritating action not only to the duodenum but like- 
wise to the rest of the intestine. By the well directed em- 
ployment of the most rigid diet, of drinks, acidulated, or only 
sweetened, of the local abstraction of blood, of fomentations and 
emollient lavements, we obtain the cure of gastric affections 
sometimes in one day, generally in a few days, and most fre- 
quently before the seventh day. We do not see them under this 
treatment continue during two or three weeks, and much less for 
the space of a month or six months, as so often happens when 
the emetic treatment is pursued. 

After we have procured the prompt disappearance of the gas- 
tric symptoms, the bilious symptoms sometimes persist for some 
days, without heat of skin and acceleration of pulse, a fact that 
indicates the continuance of the irritation of the liver. In this 
case a saline cathartic may sometimes be prescribed with advan- 
tage: it is generally sufficient to continue the diet, but with less 
rigour, as w^ell as the employment of acidulated drinks, to ob- 
tain the cure of the latter symptoms. 

I shall be reproached by some with haying insisted so much 
on the disadvantage of evacuants in the treatment of gastric fe- 
vers, while others will be dissatisfied that I have not altogether 
proscribed their employment. I do not flatter myself that I have 



134 PHYSIOLOGICAL PYRETOLOGY. 

L -:--^- -•;- vri-.'z eerie:: : : ::t: :~ :he : ses in -^hi:h these neeers 
2-^ J -ii-e:ei. I here. h:~eve7. meie the :::::;::. hrreiy rer- 
.... -, j .v.-- t'^»i - 5 r - :/.:::::::::: : ;e:.: '"■'::. :e ""~ ~: "■" ~: : ----- 



:i:::;. 



L'ier7h:ei if ene :: these STnee::n:s :: riser;: :e~er. "". :::n 
prove how little is to be expected fro m bee erne I : yment of eva- 

■:-:zz.zi. ^~hen it c::ers. :r.e c: the n::s: :f:::::.5 meers :: 

The ::::.:: shreii be dire::ei :: brink little :: 2 :inee. 
ertlv ::' ::.:v :.".: ; r : us rleies. ':.:: ::::. f •^::..i:' - ehe srgeer: e:i- 
cei.ce: 5 1 ;' . .". .-- 5 s e 1: . e :e :~";.;e_. :i:iciisrr.s si 1.1c ee :cee.r: 
he: :■: the h: : men. eciiness ce the fee: shtrii be rreven:e 
remedied by the application of hot bricks enveloped in cloths, 
c 1 by : : 1 y 1 i "-'-'- " expediE n L T fa e application of leeches on dif- 
ferent points of the abdomen, and parucolarl y above the region 
of the groin, or to the anas, is often necessary, and always 
useiaL 

Te "hi: ::::.:i~e ree:.. ; nccs: "":- :es:r: in :h:ien: We ire 
lc: ie c:s5ess::n :: 1 schchee: number ::' v.-eh :'zs-r~zi ::s. 
to warrant a positive answer to this question. Sydenham has 
proved that in these cases, even the mildest evacoants are always 
be:: series, mi thit ::::::. :;:e:cs. e:iiuii:ei :ei eiuiceretei •:- 
quids. gi~en ebnndintir in drink, end ever. ir. ieTen:en:. 55 ^- e 
the vi:ier.:e •::" this terrible iiseise. end :::en entirely irres: its 
t: : : ^ : e 5 5 . He r:.s :': served, ehe: nir::ti:s. prescribed :: the 
:c rumen cement, iimimsh :he piim '::: :: ehe since time ::::.- 
5 i : d 5 re p : r . w if in g the condition of the patient. 

hie is of opinion that they should not be prescribed until after 
the diseppe-irir.ee :: :he vitlemt sympecms. :: -^ehee the 5. :: hee: 
is entirely pmscruced by the iiseise. Every cne =: :he crese-rc" 
icy threes ~uu: this :elerriced physic:.::: - eh: rehire :: ihe dirt- 
ier ::" emetics e::i pnriecives ir. hccleri. rei ehe urility c: :he 
drinks dencminited mlr.eurru Be: ere mere, he reility. cises 
ir. ~uu::: cue emplrymen: c: nir::c:cs is pr:per : Are :iee:e net 
cises ::: v-.-ki:h :i:e i: ;ii e:s:re::i:r: c: biod is iniieeeei? Thes-e 
qees:ie~s :::: :e reseivec :y ^:::e:.T:::e ei:::e. I: is ~:e:h :: :e 
^•"iihei i.ee r.hvsi:iee.5 e:;:::5;::~ ir. ehe seehe 0: Ee::':e. in 



GASTRIC FEVER. 135 

Africa, in the East Indies, and in the hot climates of America, 
would direct their attention to these points. The inefficacy, and 
even the danger of general blood-letting in cholera, should not, 
in my opinion, prevent the employment of topical depletion. I 
have seen this mode of abstracting blood arrest, often almost in- 
stantaneously, colics of the most violent character, which if 
treated by other means, or abandoned to nature, would have con- 
tinued with the same violence for many days. The nature of 
the symptoms of cholera, and the unequivocal traces of inflam- 
mation discovered after death, favour the opinion that local blood- 
letting might diminish the ravages committed in hot countries, 
especially in India, by this disease, which is more fatal in those 
countries than in the north, and even in the south of Europe. 
The state of the skin should not be neglected. Excessive heat 
occasions a sur-excitation of the membrane, the sudden cessation 
of which, occasioned by a draught of cold air, is the most fre- 
quent occasional cause of gastric and hepatic maladies in hot cli- 
mates. 

In all diseases, and of course in cholera, it is necessary, pre- 
viously to the application of leeches, to recall the blood to the 
skin, when it is cold and pale, otherwise they will not bite or 
flow. In this case, stimulants of the mildest kind, or the most 
diffusible, such as hot water sweetened with sugar, with the ad- 
dition of a small quantity of ether, hot fomentations, the vapour- 
bath may happily fulfil the indication of restoring the activity 
of the skin. 

When, in the course of gastric fever, there arises irritation of 
the bronchia, of the pulmonary parenchyma, of the pleura, of the 
kidneys, or the bladder, it is often necessary to apply leeches to 
the sternal region or to the sides of the chest, to the loins, or to 
the perineum or even to resort to venesection, and the other 
means appropriate to the inflammation of each of these organs. 
It would often be dangerous to rely upon the disappearance of 
those secondary phlegmasiae with that which they complicate, 
and to permit them to make a progress which nothing afterwards 
might be competent to arrest. 

Inflammation of the peritoneum sometimes supervenes upon 
that of the stomach and intestines, or replaces the affection of 
the latter organs ; the diarrhoea ceases, the abdomen becomes 



136 PHYSIOLOGICAL PYRETOLOGY. 

painful in most parts; the body shrinks, the pulse becomes small; 
gastric fever then assumes the adynamic character, and conse- 
quently is classed among those fevers which shall be considered 
in a subsequent part of this treatise. 

Finke has described, under the name of anomalous bilious 
fevers, irritations of the encephalon, of the skin, of the mucous 
membrane, of the pharynx, of the bronchia, of the articulations, 
of the kidneys, of the inferior extremity of the rectum, some- 
times produced by a prevalent gastro-intestinal irritation, with 
or without hepatitis, at other times primitive, and which, in the 
latter case, were cured by provoking a transient gastro-enteritis, 
by the employment of emetics and purgatives. 

When an epidemic gastritis or enteritis, prevail in a country, 
all the inhabitants are not affected, because, although all are ex- 
posed to the causes, which, by irritating the digestive organs, 
cause the epidemic, yet all have not the same idiosyncrasy. In 
some, these organs alone are affected, in others the irritation ex- 
tends to the lungs, the encephalon, and the kidneys, affecting 
them not merely to that feeble degree which is observed in all 
cases of gastro-enteritis with sympathetic phenomena, but with 
great intensity. In the latter cases, when the symptoms of 
the irritation of the digestive organs, and those of the irritation 
of one of the organs just named, are of equal intensity, there is 
said to exist a complication of One fever with another, or with 
a phlegmasia. If, on the other hand, the irritation of the lungs, 
of the encephalon, or of any other organ, be manifest, and that 
of the digestive organs, obscure or not at all observed, physi- 
cians preoccupied by the malady which they observe in the 
greater number of persons, committed to their care, imagine 
they see it every where, — see it when it does not exist, and ad- 
mit but two varieties of the epidemic disease; viz. the one, true, 
open, legitimate; the other, false, anomalous, spurious: for 
both these conditions they make use of the same curative means. 
The result of this practice is as follows: in case the digestive 
organs are free from irritation, the emetics and purgatives, some- 
times arrest the anomalous affection with surprising promptitude; 
because the digestive organs are predisposed to irritation by the 
prevailing morbific causes. The irritation caused by the eva- 
cuants resulting from a transient cause, generally ceases with 



GASTRIC FEVER. 137 

this cause, and the disease is cured; but, if the predisposition 
to gastric irritation be very marked, the evacuants determine a 
gastro-enteritis. The affection, against which the remedial mea- 
sures were directed, even in this case, sometimes ceases, although 
more frequently it continues: in place of an irritation confined 
to a single organ, there now exists a complicated gastric fever; 
that is to say, an irritation of the stomach, complicated with an 
intense irritation of an organ more or less remote from the di- 
gestive apparatus. 

It results from this exposition of facts, that we should be very 
reserved in the employment of evacuants in the treatment of ir- 
ritations, which manifest themselves, during the prevalence of a 
gastric epidemic, even when the digestive organs do not partake 
of the irritation; that it is better to treat these irritations as though 
they originated under any other circumstances, and, finally, that 
when the gastric or hepatic irritation is conjoined with the affec- 
tion, we must employ local antiphlogistics in the case of all the or- 
gans which partake of the irritation, and not resort to evacuants 
under the vain pretext of restoring the disease to its true cha- 
racter. 

Epidemic gastric diseases require the same treatment as spo- 
radic cases; the principles are the same; the application of them 
should only vary on account of the idiosyncrasy of the subject, 
and the intensity, seat, and extent of the irritation. 

At what period of gastric fevers and of similar affections, should 
we allow the successive use of broth, soup, of cooked fruits, and, 
finally, of solid food? Broth should not be allowed until the 
heat of the skin has ceased to be acrid to the touch, and this mem- 
brane presents no trace of morbid heat, until the pulse has ceased 
to be tense and frequent, and the edges of the tongue are no 
longer red. It is proper to mix the broth with a decoction of 
gooseberries, of lettuce, or of beet: to render it less irritating af- 
terwards, there may be added a slight decoction of rice, barley, 
bread, or grouts, and by degrees the patient advances to the use 
of soup, and, finally, resumes his habitual diet. During convales- 
cence, a long time should elapse before the use of wine is allowed, 
and even wine and water should not soon be used. Before al- 
lowing the use of meat, it is proper to give the patient acid fruits 

18 



13S PHYSIOLOGICAL PYRETOLOGY. 

cooked with sugar, and fresh vegetables cooked in water, and but 
slightly seasoned. 

If there be constipation, but little food must be allowed while 
lavements are to be administered, and the patient should drink 
veal-water, a decoction of sorrel, of tamarinds, or of prunes, 
honey and water, or whey. There are only two cases in which 
purging will be proper; viz. first, when, after a return to the 
ordinary regimen, the tongue becomes foul, and the appetite di- 
minishes or disappears, without any preternatural heat of the 
skin, or acceleration of pulse: and, secondly, when the patient 
has contracted the habit of taking medicines of precaution, at 
stated periods. It must not be forgotten, that a purgative may 
renew all the symptoms. If this principle be kept in view, the 
danger of abusing; evacuants will be avoided. 

A severe regimen, the use of vegetables, the continuance of 
diluent drinks, moderate exercise, the cold bath in the case of 
young subjects, taken either before or after sun-set, according to 
the climate, are the most proper means of preventing the relapses 
so frequent after gastric fevers. These relapses are almost al- 
ways attributed to an indigestion. This is easily accounted for, 
when we consider that gastric fever is only an irritation of the 
centre of the digestive system; to prevent which I cannot be- 
lieve, that any experienced physician of the present day, would 
prescribe bitters, with the view of restoring the tone of the sto- 
mach. This Brunonian practice, is probably now abandoned by 
those who formerly recommended it, and whose names, there- 
fore, need not be mentioned. The administration of tonics at 
the decline of bilious fevers, far from rendering convalescence 
short, tends directly to its prolongation. 



MUCOUS FEVER. 139 



CHAPTER IV. 



Of Mucous Fever. 

Selle, has designated by the name of pituitous fever, and M. 
Recamier, by the name of pepsic mucous fever 9 the diseases 
preceded and accompanied by the following phenomena; viz. a 
cold and damp atmospheric constitution, food of a bad quality, 
or in small quantity, or the total want of it; the tongue charged 
with a mucous substance, white, and, as it were, lardaceous, 
which likewise covers the mouth and pharynx; a mucous coat, 
covering the blood and formed in layers, the interstices between 
which are filled with serosity: the clot dissolved, a slow, feeble, 
and intermittent pulse; the urine clear and limpid. These cha- 
racters, taken from Sarcone, give but an imperfect idea of the 
fevers observed by this physician, and of those which Rcederer 
and Wagler have described with so much care. Pinel has en- 
deavoured to give an exact summary of the observations of these 
three physicians. His description of the disease is as follows; 
viz. 

A sense of general malaise, of weight in the limbs, disturbed 
sleep, loss of appetite and acid eructations, often announce the 
invasion of the mucous fever, which commences in the evening 
or during the night, with a sense of cold without trembling, 
felt first in the feet, and afterwards pervading the whole body. 

The symptoms of this fever, are the following; viz. a whitish 
and moist covering of the tongue, a viscous, and sometimes an 
abundant salivary secretion, a sour or nauseous taste, aphthae in 
the throat, on the parietes of the mouth and on the lips; thirst, 
generally of little intensity, want of appetite, and sometimes a 
marked repugnance for food, acid or nidorous eructations, a sense 
of weight at the epigastrium, and a swelling of this part, nau- 
sea, a vomiting of white viscous and transparent matters, insipid 



140 PHYSIOLOGICAL PYRETOLOGY. 

or acid; sensibility of the abdomen awakened by pressure; co- 
lics, flatulency; sometimes constipation; at other times a diar- 
rhoea of matters similar to those ejected by vomiting, which are 
sometimes bloody, and the evacuation of which is attended with 
tenesmus; frequently a passage of intestinal worms by the mouth 
or by the anus; the urine suppressed or very abundant, of a ci- 
tron colour at the commencement, thick, troubled, white or red- 
dish, with a sediment which is grayish, about the middle of the 
disease, and lateritious towards the termination ; it is sometimes 
passed with difficulty and even with pain. The temperature of 
the surface is not more elevated than in health. When the skin 
is hot, it is only so at intervals, and this heat does not appear 
acrid, except after a prolonged touch. The cutaneous transpi- 
ration is rather diminished than augmented, without the skin 
being very dry: there is often a partial sour sweat, which occurs 
especially during the night, in the morning, and during sleep, 
principally towards the decline of the disease. Diverse erup- 
tions appear on the skin during the night, disappear, and mani- 
fest themselves anew. The pulse, sometimes differing but little 
from the natural state, is generally weak and small, and often 
slower than in health; but in the evening and during the night, 
it becomes frequent. The patient experiences a sense of weight 
and pain at the top and back of the head, — is affected with som- 
nolency and with vertigo, when he sits up, and frequently suf- 
fers from a confusion of ideas: his mental powers are prostrated; 
he is sleepless, — always dejected; restless and despondent; he 
is constantly complaining, and suffers from contusive pains, often 
insupportable, in the hypochondria, along the limbs, and in the 
articulations. 

To those symptoms, are frequently joined others, such as in- 
termission of the pulse, a dry cough, dilatation of the pupils, 
augmented lachrymal secretion, hollowness and brilliancy of the 
eyes, itchiness of the nostrils, pains at the root of the nose, pe- 
culiar noises in the ear, deafness, grinding of the teeth, trismus, 
risus sardonicus, palpitation, dyspepsia, precordial distress, 
pricking pains at the epigastrium, partial or general convulsive 
movements. These symptoms, according to Van Den Bosch, 
Rhan, and Bruning, indicate the presence of worms in the di- 
gestive passages; but Dehaen has proved, and the experience 



MUCOUS FEVER. 141 

of every day confirms the fact, that all these phenomena may 
exist independently of worms. 

The mucous fever does not always follow a uniform course: 
we observe exacerbations, and even distinct paroxysms; some- 
times occurring at indeterminate periods, though generally in the 
evenings or during the night. They usually recur every day, 
though often with the quartan type, sometimes, with the double 
tertian, and more rarely with the tertian type. There is a re- 
markable slowness of the pulse at the termination of those exa- 
cerbations, and the heat and sweat is but little augmented. The 
paroxysms are often very long and interrupted by irregular ri- 
gors. 

The duration of this fever, varies from fifteen to forty days 
and upwards. It seldom terminates in a week, and its continu- 
ance is longer in proportion as the paroxysms are more marked. 
It terminates, 1st, by a return to health, after vomiting, diar- 
rhoea, aphthae, pustules, or a miliary eruption, general sweats, a 
flow of urine with a slight sediment, which is white, lateri- 
tious, or yellow; or, finally, after an abundant salivation: these 
symptoms may manifest themselves at variable periods, which 
it has been in vain attempted to determine; 2dly, by the deve- 
lopment of unequivocal symptoms of rheumatism, pleurisy, or 
peripneumony; 3dly, by death, after an obstinate diarrhoea, a 
pleurisy, an obscure peripneumony or arachnitis, excessive par- 
tial sweats, an increase of the symptoms of weakness or of the 
nervous symptoms; 4thly, by a chronic affection of the bron- 
chia, of the lungs, of the viscera of the abdomen, by anasarca 
or ascitis. In the latter cases, the fever often becomes intermit- 
tent, and is indefinitely prolonged. 

The complication of the mucous with the inflammatory fever, 
admitted by Roederer and Wagler, is contested by Pinel. The 
complication with the bilious fever has been observed by the 
same authors, and by Plenciz. To the principal phenomena of 
mucous fever are then joined some of those of the bilious fever; 
such as force and hardness of the pulse, at least at intervals; a 
greater degree of thirst, the presence of bile in the matters vomit- 
ed, and in the alvine dejections. The mucous fever, according 
to Pinel, may be complicated with high inflammation of the 
alimentary canal, tending to gangrene, a comatose state, with 



142 PHYSIOLOGICAL PYRETOLOGY. 

an intense affection of the lungs, or with any other inflamma- 
tion: complications which reverse the ordinarily favourable 
prognosis of this disease. 

Relapses are frequent in the convalescence from mucous 
fever. 

It has been said of the mucous, as well as of the gastric fever, 
that it could not occasion death except by complicating itself 
with adynamy or ataxy; but before this theory was proposed, 
we were in possession of admirable descriptions of the traces 
left by the disease, which I shall describe in a summary man- 
ner. 

In 1761, at Gottingen, Roederer and Wagler found, on post mor- 
tem examination, the albumen distended by a fetid gas, and serosi- 
ty in the cavity of the peritoneum ; 2dly, the serous membranes of 
the intestines covered with bluish, blackish, and gangrenous 
spots, more or less extended and numerous; 3dly, the gastro- 
intestinal mucous membrane always thickened, inflamed, red,* 
bluish, ash-coloured, blackish, gangrenous, spotted with red 
points, with aphthae, with vegetations, or little pustules formed 
by follicles largely developed, and very apparent, and covered 
with a thick, and frequently a tenacious mucus: the intestines 
often filled with lumbrici. The alterations of this membrane 
generally involved the stomach and small intestines, particularly 
the duodenum, which sometimes was alone affected. The sto- 
mach was rarely devoid of redness, but the follicles were less de- 
veloped, except near the pylorus; the membrane of the great intes- 
tine frequently participated in the alterations of that of the small 
intestines, and was, even more frequently than the latter, af- 
fected with vegetations, and covered with ulcerated spots; 4thly, 
the mesentery inflamed or gangrenous, principally in the parts of 
this membrane which corresponded with the inflamed or gangre- 
nous portions of the intestines; 5thly, the mesenteric glands fre- 
quently enlarged, hard, inflamed, red, or brown, especially those 
which corresponded to the same portions of the intestines; 6thly, 
the liver generally granulated, often very much enlarged, hard, 

* Semper in canali alimentari ham externa? quam interna? inflammationis 
notae observantur. Rcederer et Wagler, De Morbo Mucoso. Gcettingues, 1743, 
p. 242 et 249. This quotation is not unnecessary, since the expressions of 
these excellent observers have been singularly misquoted. 



MUCOUS FEVER. 143 

sometimes red or blackish at its surface, the spleen of a deep 
blue; large and soft, or small and hard; 7thly, the lungs often 
adherent, inflamed, hepatized, gorged with mucosity, sometimes 
purulent, often tuberculous, the bronchia frequently red; the 
bronchial glands often enlarged, black, and hard; the pericardium 
more or less filled with a serosity which was sometimes bloody. 

During the epidemic mucous fever observed at Naples, in 
1764, by Sarcone, Cotugno, Gervasi, and other celebrated prac- 
titioners, the examination of the body gave the following re- 
sults: — 

More frequently, says Sarcone, the internal changes did not cor- 
respond to the violence of the most formidable symptoms of the dis- 
ease, particularly when convulsions have been the principal pheno- 
mena, and when the patient had fallen a victim to their violence 
in the course of the first week, or, at the farthest, in the com- 
mencement of the second week. But when the disease had mani- 
fested an extreme degree of activity, great changes were observed 
in the body. When meteorism had preceded death, the viscera 
of the abdomen displayed, on examination, unequivocal signs of 
the highest degree of corruption. Most frequently the intes- 
tines were marked with livid irradiations, or with spots resem- 
bling petechias. Their cavity was almost always covered with 
a tenacious and shining mucus, sometimes of an ash colour, 
at other times, yellow, and resembling a species of membrane, 
which, when detached, discovered the subjacent part inflamed, 
or gangrenous. The alterations were not always more serious 
in the small than in the large intestines. Frequently the latter 
were wonderfully swelled, covered with mucus, and a foul mat- 
ter of various aspect, and extremely fetid. They were gene- 
rally swelled unequally, and as it were, strangulated in certain 
points; this phenomenon was observed particularly in the colon, 
which was sometimes found loaded with dry and hard fecal mat- 
ter: worms are not always found. The great intestine was ge- 
nerally erysipelatous in those who had been affected with a diar- 
rhoea, which had passed into dysentery, and continued until death. 
This appearance sometimes extended to the small intestines. In 
this case, the mucous membrane appeared to be destroyed in cer- 
tain points, and, in some places, was absolutely wanting: in cer- 
tain places which were thus denuded, there transuded a sanguino- 



144 PHYSIOLOGICAL PYRETOLOGY. 

lent matter. In other parts of this intestine, there was a sort of 
incrustation of thick and shining mucus, under which the mem- 
branes were usually found red, covered with small white pus- 
tules, resembling aphtha?, or marked with spots which were livid, 
or pale and ash-coloured. In two patients who had suffered from 
dysentery, the rectum was found affected with an erysipelatous 
inflammation. In the cavity of the duodenum, and in its vici- 
nity, the bile had left traces of its passage: what these traces 
were, has not been stated. The stomach generally appeared di- 
minished in size. Most of the victims of this epidemic had 
suffered much from hunger. The parts of this viscus which 
were most sensibly changed were the cardia and the pylorus: 
these parts appeared erysipelatous, or marked with sanguineous 
irradiations, or too morbidly white, or of a deep and sometimes 
of a gangrenous red. The mucous membrane of the stomach 
was covered with a tenacious mucus, or with a small quantity of 
a yellow or greenish matter. This mucus and tenacious cover- 
ing, extended as far as the oesophagus, w r here it formed a kind of 
false membrane. When there had been no alvine dejections, the 
gall-bladder was gorged with bile. The substance of the kidney 
was always found vitiated, when death had been preceded by a 
violent hiccough. Cotugno states, that he had observed that the 
mesenteric glands, nearest to the intestines, were increased in 
size. On one occasion, only, the traces of inflammation of the 
diaphragm were observed. The pleura was covered with a thick 
false membrane. Large extravasations of serosity, or of a pure 
sanguineous matter, were almost always found in the chest. The 
lungs were often hepatized, and, as it were, emphysematous. 
On opening the chest, they appeared swelled and distended; but, 
upon being divided or pricked, they contracted instantaneously. 
Demauro found serosity upon the brain, and in the ventricles, 
the meninges hard, thick, and steeped in a thick and tenacious 
lymph. 

The history of the epidemic of Naples, has often been cited : 
but the anatomical researches have been passed over in silence, 
because they did not fall in with the prevailing theories. Sar- 
cone himself did not know how to turn them to advantage: we 
may, however, remark, with this physician, that it is useless to 
advocate post mortem examinations with those who consider 



MUCOUS FEVER. 145 

them unnecessary, because such opinions generally result from 
vanity or ignorance. " Cadavera hominum morbis denatorum 
medico secunda sunt mamisque inquinandse ut inveniat quae 
morbi sit sedes, quae causa, quis exitus antecedentum symptoma- 
tum; qui demum effectuum omnium in antecedenti morbo obser- 
vatorum eventus."* " The opening of bodies," says Lepecq,t 
" ought to inform us what organs have suffered lesion, and in 
what their morbid alterations consist." 

The pathological anatomy of the alimentary canal will find a 
more appropriate place in the following chapter. 

The following causes have been assigned to the mucous fever; 
viz. infancy, old age, the female sex, a lymphatic temperament, 
a state of languor or paleness, chlorosis, a constitution weak- 
ened by scurvy, or chronic intermittent fever; 2dly, A resi- 
dence in low, damp, marshy districts, deprived of the solar rays; 
the season of autumn; cold ground with humidity; want of clean- 
liness, the bath after meals, the suppression of habitual cutaneous 
diseases, of arthritis or rheumatism; 3dly, The want of food, 
or, at least, of fresh vegetables, the use of indigestible food, 
such as farinaceous articles, not fermented, unripe, sweet or acid 
fruits, damaged provisions, muddy, brackish water, the privation 
of wine where it has been habitually used, the abuse of emetics 
and purgatives, intestinal worms, organic lesions of the abdo- 
men, such as tabes mesenterica, excessive evacuations, chronic 
catarrh; 4thly, The abuse of venery, prolonged watching, ex- 
cessive study, inactivity, or too active a life, habitual depressing, 
moral affections, &c. 

In the preceding chapters it has been thought unnecessary to 
insist on the nature of inflammatory and gastric fevers: since, for 
the sake of avoiding repetition, this point will be discussed in a 
general manner at the end of this work, and since few physicians 
of the present day deny that these fevers are caused by irritation. 
As there are many who do not entertain the same opinion with 
regard to the mucous fever, I must enter into some details to 
prove that this fever consists in an irritation which is not of a pe- 
culiar nature, and which is not general. 

* Baglivi Praxis Medica, 1. 1, c. 5. 

f Collection d'Observations sur les Maladies et Constitutions epidemiques. 
Paris, 1776, 3 vol., in 4to. 

19 



1 4 : PHYSIOIXJGICAI. P YRETOIXJGT . 

It cannot no w be necessary to relate the opinions of GaJ 
Charia le ? Sclle, StoD, Sarcone, Bcederer. Wagfer, 

P. 7:-iz>. -::.- rerir: :.: - ....e : :. r". : i :. : - : :' ±e s^nsirr. -.:.e ; 
i.:i ::^ ::^:,:: :::. ::.- -.:: i :::.: ::. ; :' ±err.u::"_.5 fever. 
■ritbutandinc hn xvawn :o the humoral pathology, Pine 

r.:: ii"-:.: :.: :-e :=-- :'::~ i :::■..•.-...;.; ±: - f • T - i: _-;';,-: :: -;- 
~ : : : 5 . "... = 5 . :::;:.it: :r. '.:.-. liz eniirv ;... ~ ;.t - .-;•:: : 
fever. Ye: he :e~ir£5. •• ~^~e :.iz.z:: '::: reierrhie i::: 
aft : I f . * peculiar irritation of the mneoos 

ztl-~ :: -...:. e e:..z:2e v_^; — -._:-. :v 1 >:r: :: rmi :.:..::.. : : 
'::.i:::e -.:.:. ±e :ihe: 5— zi-:.::r_5 ::' "... . t : : :. :~; 

- I::. :ef::e he ree: 

.:::. ::" ir. e r,:cif: = r_ 1 

- r _ . _ ... .-, . __.. 

?, ... — r.r.r — _r. 

vi.>:e: :,:: .::..: reli 



i~ the !...."•; 



: iu'.is- 1: '.e.L5t iz ~r.e cir:th.st.:rr iii i :ze>i-ve svstezii.. li£ ever. 
ir. :..t ::.-..::. ir. everv ;- In.:.. :~e :: the.fe irriis ;:ee:r...- l : e 5 . 
:_: ::. r-e^-ersl ±€ I:ze?r.ve 5y5te~ 1.5 the ~ est i.::.:ve.. It:*, 
Lr. e rezc re-. r_ 1 * 5 . r 7. r . f . z. ^ :....:: '... . e ~: l ~.~. : 5 : e ~ z r 15 i "~ "**/ „ ? r. : . 5 - 
ease of this early period. In old men it is in the digestive ap- 
eirivj th-t the ~.:.iL i:~.;z. ee:f.5..5 .:z.z-.5~- their 
5i.i :: :e £—175 ierizrei. en -..:_:? if rr:e: :u: thif 
ment is generally agor-excitation, which manifests itself only in a 
^..5-.-::l- :e ::' :".:--_:.-.. :::. :::: .:.: ::' ±i e: kie.5.5 ::' the 5v~- 



>":& ;!.. ::zi 1 : !:■: 



MUCOUS FEVER. 147 

pathies at this age. Women are not weaker than men; they are 
even in general more irritable, and their digestive apparatus is 
more subject to irritation than that of men: it cannot then be 
wondered, that in an epidemic mucous fever, they are more rea- 
dily affected. Paleness, slowness of motion, muscular weak- 
ness, whether habitual or dependent upon convalescence from 
any disease, do not prove that the digestive organs are labouring 
under atony; the contrary is more frequently the case. There 
is certainly atony of the circulation in chlorosis and scurvy, but 
this atony forms a condition favourable to the development of 
any irritation whatever; if during this state no cause sur-excites 
the digestive organs, the phenomena of mucous fever will never 
manifest themselves. 

It is certain that cold and humidity debilitate the skin, at least 
at first; but it is not less certain that these two atmospheric con- 
ditions determine at the same time a sympathetic increase of ac- 
tivity in one or more internal parts: this is proved by the in- 
creased lachrymal secretion, by coryza, leucorrhcea, odontalgia, 
angina, bronchitis, pleurisy, pneumonia, pain in the forehead, 
the temples, the breasts, the precordial region, the epigastrium, 
the loins, the hypogastrium, the testicles, the articulations, and 
the limbs, occasioned by the humid cold, according to the pre- 
disposition of the individual and the other circumstances to 
which he has been subjected. J have too frequently observed, both 
in my own person and in others, the stimulating influence of 
cold and humidity united, to permit me to entertain the slightest 
doubt upon the subject. This stimulation is most frequently 
felt in the digestive organs, especially if the patient has been 
using an improper diet; those organs being the most excitable of 
all those that form the human body. We cannot, therefore, 
be surprised that humid cold produces the mucous fever, since 
the seat of these fevers is the digestive apparatus. 

The absence of the solar rays is doubtless one cause of debility; 
affecting first the skin, then the brain, and in succession the rest 
of the body; but can this cause alone produce the mucous fever? 
Want of cleanliness, by diminishing more or less the perspirato- 
ry action of the skin, the suppression of the irritations of this 
tissue, or of those of the articulations, the nerves, and the mus- 
cles, predisposes to this fever, only by determining a supplemen- 



148 PHYSIOLOGICAL PYRETOLOGY. 

tory activity in the digestive organs. If the bath after meals has 
ever occasioned the mucous fever,, the fact is not a surprising one: 
for. to produce this result, it is only necessary that it give rise to 
an indigestion. 

The privation of food may occasion, if not a mucous fever, pro- 
perly so called, at least the principal phenomena which characte- 
rize it. An abstinence of four days during health, from every 
thing except water, has assured me of this fact in my own per- 
son; but it is not true, that these phenomena are occasioned by 
weakness of the stomach. The physicians who have devised this 
wild etiology could have had no idea of the painful sensations at 
the epigastrium, and the sudden perspiration experienced in these 
cases. The tongue is red at its edges and point,, and covered with 
a thick and white coat in the middle,, the thirst is excessive,, the 
skin burning, and the stomach so little weakened that a spoonful 
of wine occasions pains,, such as are experienced in a commencing, 
though already well characterized gastritis. 

To place organic diseases of the abdomen, and especially the 
tabes mesenterica, among the causes of mucous fever, cannot but 
confuse the reader. What organic lesions are meant? Is not 
the tabes mesenterica recognised at the present day as a mesen- 
teritis, sometimes primitive, much more frequently owing to 
chronic enteritis? The bare assertion that the presence of worms 
in the digestive organs is one of the causes of this fever, is not 
sufficient; the fact requires proof: this neither has been nor can 
be given. All that can be said upon this subject is, that the ir- 
ritation which constitutes the mucous fever, is often accompanied 
by the presence of these animals in the alimentary canal, but we 
are in complete ignorance as to any effect they may have in the 
production of this fever: they merit much less attention than has 
been bestowed upon them. In vain has Lepecq pointed out the 
following signs of their presence, which, he thinks, should deter- 
mine the physician to adopt measures for their expulsion: nau- 
sea, syncope, pains pervading the whole body more violent in 
the head, and especially in the thighs, when they are rather 
gnawing than accompanied with a sense of weight: morbus ven- 
triculi, colics, flatulence, a transient prominence of the abdo- 
men, vertigo, delirium ceasing and returning suddenly, convul- 
sions, tremors of the limbs, tremulous motions of the lips, phren- 



MUCOUS FEVER. 149 

sy, a desire to bite, variation of the pulse, which is sometimes 
strong and at other times depressed, small, frequent, unequal, 
and intermittent. None of the morbid phenomena announce 
with certainty their existence; unless there are found pieces of 
the worms, or whole worms; they are seldom seen in the mat- 
ters vomited, more frequently in the alvine dejections. M. 
Bremser admits no other certain and infallible sign of their ex- 
istence.* Even in those cases in which the evacuation of worms 
has been observed, the symptoms attributed to their action upon 
the gastro-intestinal mucous membrane very frequently continue, 
when, on examination, none are found in the alimentary canal. 
Georget has, with reason, attributed to a lesion (which I must 
remark is often sympathetic,) of the encephalon, the symptoms 
which have generally been ascribed to worms, t Brera has ju- 
diciously remarked, that the evacuants resorted to for the expul- 
sion of worms, often do not act efficaciously, unless emollients 
have been previously administered. Pinel deserves great praise 
for having banished the order of verminous fevers admitted by 
Selle and many others; but he should not have ranked worms 
among the causes of the mucous fever, since they themselves are 
only an effect of the causes which produce this fever. 

The assertion has been made in too general a manner, that ex- 
cessive evacuations debilitate: if they diminish muscular action, 
they exalt sensibilit} 7 , unless they are accompanied by too lively 
a sensation, as in coitus; but even this act is not succeeded by a 
general debilitation; the brain is rather in an apoplectic than in 
an asthenic state; the head is heavy and painful; there is a ten- 
dency to sleep; or a sense of pain in the stomach, and an irresisti- 
ble desire for food, which indicates an excitement of the gastric 
passages, analogous to that produced by long abstinence. The 
same remarks may be made with regard to repeated watching; 
profound meditation, and melancholy, which destroy the ap- 
petite, only when the brain having become painful, produces a 
sympathetic irritation of the stomach. 

* Traite sur les Vers Intestinaux des Hommes. Paris, 1824, in 8vo. 

f De la Physiologie du Systeme Nervcux, Specialment du Cerveau, 
Recherches sur les Maladies Nerveuses. Paris, 1821, tome 1, p. 420, in 8vo; 
chez J. B. Balliere. 



150 PHYSIOLOGICAL PYRETOLOGY. 

It is not correct to assert in a general manner that indolence or 
too active a life debilitates. Indolence weakens only the organs 
which remain inactive; and the assertion, moreover, is not rigo- 
rously true, since repose excites the organs of sense; inordinate 
exercise determines pain in the muscles and a cerebral sur-ex- 
citement, which render repose necessary, rather than debility 
of these parts. 

It may fairly be concluded, from this examination of the causes 
of the mucous fever, that if some of them have a debilitating 
influence, yet none have this effect upon the whole economy; 
that none of them debilitate the digestive organs, and that, on the 
contrary, all the occasional causes of this fever act by stimulating 
directly or sympatheticlly the gastro-intestinal mucous mem- 
brane. The physiological study, therefore, of these two orders 
of causes points to gastro-intestinal irritation as the proximate 
cause of this fever. This is also demonstrated by the unequi- 
vocal symptoms, (although they are frequently less apparent 
than in gastric fever,) of gastro-enteritis, observed in the mucous 
fever. Finally, on examination after death, traces of inflamma- 
tion of the gastro-intestinal canal are almost constantly discovered ; 
consequently, the principal phenomena of the mucous fever are 
generally to be traced to gastro-enteritis. 

Roederer and Wagler have attempted to establish a distinction 
between the traces of simple mucous fever and those of inflam- 
matory mucous fever; but the result of their observations shows 
that the difference is only in degree. 

It remains to give an account of the mucous symptoms which 
particularly characterize this fever. These symptoms are the 
white and thick coating of the tongue, the nauseous taste, the 
vomiting and dejections of mucous and glairy matters. What do 
these symptoms indicate? An augmentation of the secretion of the 
gastro-intestinal mucous membrane. This increase of secretion 
does not announce an irritation sui generis, a specific irritation 
differing from the irritation without augmented secretion, (at 
least at the commencement and in the highest stage of the dis- 
ease,) which constitutes the gastric fever. This increased secre- 
tion, which appears from the commencement of the irritation 
of the gastro-intestinal mucous membrane, which augments and 
diminishes with it, cannot be the cause of this irritation. The 



MUCOUS FEVER. 151 

existence of this irritation is incontestable; irritation cannot co- 
exist with atony in the same organ; this secretion then is not 
the result of atony, of relaxation of the gastro-intestinal mucous 
membrane, but of irritation of this membrane. Should the ques- 
tion be asked why the gastro-enteritis, constituting mucous fever, 
is accompanied by mucous symptoms, which are not observed 
in the gastric fever, the answer is easy: the question should not 
be why; but when and how: now, the experience of all times 
and all places has proved that an increase of secretion mani- 
fests itself, whenever the gastro-enteritis is the result of 
humid cold, of the use of gross rather than of stimulating food, 
in certain subjects of soft skins and pale tissues. To this the 
distinction, which has so little foundation in nature, between 
inflammation, properly so called, and catarrhal inflammation, 
or catarrh, reduces itself. Pinel, having admitted the identity 
of these two morbid states, was inconsistent in attributing 
the mucous fever to irritation sui generis. It may be ad- 
mitted that the follicles of the gastro-intestinal mucous mem- 
brane may feel more sensibly the influence of humid cold, since 
it suppresses the secretory action of the skin, and the mucous 
membranes supply the deficient action by an increased secretion. 
The anatomical researches of Roederer and Wagler tend to de- 
monstrate this proposition. Perhaps a sufficient distinction is 
not made in pathology between the follicles and the membrane 
in which they exist. However cautious we should be, not unne- 
cessarily to multiply the tissues of the body, this distinction ap- 
pears admissible, although it is likewise certain, that the mucous 
membrane itself is inflamed in the mucous fever. 

Cold and humidity do not affect the gastro-intestinal mucous 
membrane alone: it is not uncommon to observe coryza and 
bronchitis preceding the gastro-enteritis, which constitutes the 
mucous fever. Bronchitis frequently persists during the whole 
course of the latter; the irritation often propagates itself to the 
pulmonary parenchyma, or repeats itself in the pleura; a perip- 
neumony, or a pleurisy often misunderstood, then complicates 
the gastro-enteritis, increasing the danger of the disease, and 
frequently passing into the chronic state after the cure of the 



152 PHYSIOLOGICAL PYRETOLOGY. 

gastro-intestinal irritation. The latter, also, very frequently be- 
comes chronic, and when it extends its influence to the perito- 
neum, it determines ascites. Nothing is more common than 
to observe the different irritations which give rise to the mu- 
cous fever: at length, ceasing to provoke the action of the heart, 
and prolonging themselves indefinitely. This result is more 
frequently witnessed from the circumstance of these irritations 
being ordinarily treated, by a method inappropriate to the na- 
ture of the disease. 

The greater number of facts which I have been able to col- 
lect, since the publication of the first edition of this work, a 
more careful consideration of those which I collected in the 
army, and a more attentive study of the treatises on epidemics, 
have convinced me, that simple bronchitis may occasion most of 
the phenomena, the collection of which, constitutes the mucous 
fever; that in old men, an acute inflammation, though not of the 
most intense character, of the mucous membrane of the bladder, 
may produce a similar effect; that an inflammation of the articu- 
lations after a forced march, during a wet season, may give rise 
to the same symptoms; that, in this case, the inflammation fre- 
quently ceases in the joints, and manifests itself in the digestive 
organs, or it develops itself in the latter, without ceasing in the 
former; that there are many cases in which the small or the great 
intestine alone is inflamed, the stomach preserving its normal 
condition. It is, however, true, that the mucous fever is gene- 
rally a gastro-enteritis: but to be only acquainted with what is 
most frequent, and to be ignorant of the exceptions, must ex- 
pose the physician to reverses and regrets. 

There is not only a gastro-enteritis in mucous fever, when it 
is accompanied by taciturn delirium, agitated dreams, vertigo, 
somnolence, or obstinate insomnolence, when the disease conti- 
nues many weeks, and we observe periodical returns of these 
dangerous symptoms, without exacerbation of the gastric and 
mucous symptoms. The encephalon is then affected to a cer- 
tain degree: this may have been the case from the commencement 
of the disease, or even previously, owing to the influence of cer- 
tain causes, or it may have arisen during the disease, under the 
influence of the gastro-enteritis. In this case, is observed, what 



MUCOUS FEVER. 153 

is considered a complication of the mucous with the adynamic 
and ataxic fevers, or the conversion of the first into one of the 
latter, or, finally, its transition to the state of typhus. 

After the remarks which have been made with regard to the 
powerful action of cold and humidity united, of abstinence and 
the use of indigestible food, it can easily be conceived, that the 
mucous fever should show itself epidemically in autumn, at the 
beginning of winter, and even at the end of the spring, when 
this season has been somewhat cold and there have been early 
rains. It will readily be understood, that the cold and humid 
atmospheric constitution acts with greater force in low, damp, 
foggy places, covered with forests: in these places, this fever is 
found to prevail epidemically, not only during cold and damp 
seasons, but even when these two atmospheric conditions are by 
no means marked. 

When a very hot summer is succeeded by a damp and uncom- 
monly cold autumn, the influence of the heat being still felt in 
the secretory apparatus of the bile, at the same time that the 
cold and humid atmosphere acts upon the digestive organs, there 
is observed, in many patients, a union of the symptoms of gas- 
trointestinal irritation with those of the augmentation of the 
bilious and mucous secretions. When during exposure to the 
causes which produce the mucous fever, an individual indulges 
in excesses of the table, making an immoderate use of succulent 
articles of food, generous wines, and spirituous liquors: this 
concurrence of symptoms is often observed. Such is the double 
source from which is derived the bilioso-mucous fever, or the 
complication of the gastric or bilious with the mucous fever: it 
is impossible in any other manner to account for the complica- 
tion of two diseases of the same nature, the seat ,of which is 
nearly the same. 

The complication of the inflammatory and the mucous fever, 
is not so chimerical as Pinel imagined: it is observed when the 
causes of the epidemic prevalence of the latter disease, are so 
intense as to affect those individuals in whom the circulatory ap- 
paratus is possessed of great force, or when to the gastroenteri- 
tis, which principally constitutes mucous fever, is added an in- 
flammation, sometimes latent, frequently misunderstood, of the 
lungs. To the gastric and mucous symptoms there are united 

20 



154 PHYSIOLOGICAL PYRETOLOGY. 

the signs of a high excitation of the heart, together with the phe- 
nomena of the thoracic phlegmasia; the cheeks are flushed, the 
pulse is full, hard and strong, and the skin very hot. 

Treatment of the Mucous Fever. 

The inference from the preceding observation, is, that the 
diseases which are designated by the name of mucous fever, are 
most frequently primitive gastro-enteritis, developed under the 
influence of humidity, cold and a bad regimen, and usually af- 
fecting subjects, whose mucous membranes are disposed to se- 
crete abundant mucosities: that the irritation often involves the 
whole extent of the air-passages, and of the digestive organs; 
that the gastro-enteritis may be accompanied by an arthritis, a 
pleurisy, or a peripneumony, either latent or manifest, by an ir- 
ritation of the encephalon, by a high irritation of the heart, or 
finally, by a sympathetic irritation of the biliary apparatus. 
These circumstances constitute so many shades which it is im- 
portant to recognise, as the treatment is not absolutely the same 
for all. 

The gastro-enteritis, which ordinarily constitutes the mucous- 
fever, presents, likewise, shades of intensity to which it is im- 
portant to pay attention. Thus, the signs of irritation are well 
characterized, unequivocal, with or without diarrhoea, and the 
disease proceeds with rapidity; or the phenomena of gastro-en- 
teritis are obscure, of slight intensity, to a certain degree ob- 
scured by those which announce an abundant secretion of muco- 
sity, or a mucous turgescence of the diseased membranes. AH 
these shades require a modification of the treatment. 

There are, if I mistake not, at least eight varieties of mucous 
fever, which the desire of nosological simplification has occa- 
sioned to be passed over without observation, which, however,, 
it would be irrational to treat by a method absolutely the same, 
as pyretologists have advised. Let us, in a few words, pass in 
review their opinions with regard to the treatment of this fever. 

Servile imitators of their predecessors, Selle, Stoll, and J. P. 
Frank, have only had in view the expulsion of the glutinous mu- 
cous or pituitous matter, to which they attributed the disease. 
"The first indication," says Selle, "is the evacuation of the 
phlegm which covers the internal surface of the intestines." 



MUC0U9 FEVER. 155 

"We must," says Stoll, "open the obstructions, resolve the 
thickened humours, and evacuate them by the aid of salines, in- 
cisives, and resolvents, by a mild emetic given from time to 
time with copious draughts of water, by emetics in alterative 
doses, by purgatives administered in a similar manner, and af- 
terwards by bitters and tonics." Of what consequence is it that 
they recommend not to heat too much, to be reserved in the 
use of active stimulants, and that they say that this case is one 
in which we should be cautious of proceeding with haste? It is 
evident that these physicians have been guided in their practice 
by a false theory, and not by experience, as they so frequently 
assert. Baglivi himself, while he advised emollients and even 
venesection, had admitted the necessity of having recourse, in 
certain cases, to mild purgatives from the commencement, 
when there were in the digestive passages matters in fermenta- 
tion: these remedies were to be succeeded by stomachics. J. P. 
Frank has only copied F. Stoll and Sells, rejecting their theory 
while he adheres to the practice founded upon it. Although he 
has recognised irritation of the gastro-intestinal mucous mem- 
brane in the mucous fever, he still advises an emetic at the com- 
mencement, to remedy the atony of the stomach, the nausea 
and vomiting; he prefers ipecacuanha, either, he says, as an 
evacuant or to communicate a slight astriction to the alimentary 
canals and to remedy the relaxation, which appears inseparable 
from the affection, (that is to say, the irritation, even according 
to this professor,) of the mucous membrane.* He advises the 
repetition of the latter remedy, and recommends its administra- 
tion in a mild aromatic infusion; he advises, likewise, the fre- 
quent exhibition, in small doses, of a mixture of rhubarb with 
super-tartrate of potash or hydro-chlorate of ammonia; or, after 
the example of Rocderer and Wagler, three or four grains of the 
resin of jalap in an emulsion; finally, to remove every obstacle 
to the course of nature, that is to say, to prevent the delay of 
irritating matter in the bowels and to guard against the too de- 
bilitating effect of evacuants, he advises to commence with an 
emetic, and afterwards, to employ mild laxatives, emollients and 
tonics. It is evident that Pinel was contented to adopt, upon 

* Nos. Phil, tome 1, p. 121. 



156 PHYSIOLOGICAL PTBETOUOGY. 

the authority of Ro&derer and Wa^cr, opinions which he should 
have submitted to the test of experience, is it not surprising that 
in the treatment of mucous fever he has not spoken of the ad- 
vantages of the expectant method? 

If it be true that every increase of secretion is the index of an 
augmentation of the vital movement of the part in which it oc- 
curs, and if the augmentation of the secretory action of the gas- 
trointestinal mucous membrane be the special characteristic of 
the mucous fever, does it not involve an inconsistency, to solicit 
this secretion, to excite it by the employment of evacoanls? 
How mild soever may be the emetics and cathartics, it is neces- 
sary, to produce the desired evacuation, ihat they irritate a mem- 
brane already in a state of irritation, and thus the remedy adds 
to the action of the morbific cause. Admitting mat evacoants 
are proper, is it not in conform. 77 — .-. . 7 _ : 7- 

ceived opinions that emetics and cathartics leave 
debility, but a certain degree of irritation? What good 
then can be subserved by their alternation with tonics, or rather 
is it not absurd and even danger : ; : : : z : :. v.z. 7 

the strainers of the gastrointestinal mucus? The more we 
reflect upon this subject, and the more frequently we hare an 
opportunity of seeing the mucous fever treated by evacoants 
and tonics combined, the more we shall be convinced that if 
this disease generally prolongs itself for several weeks, if it be 
accompanied in most cases with exacerbations of great intensity, 
and, finally, if it terminates frequently in death, it is because this 
mode of treatment increases the irritation which constitutes it. 

If evacuants sometimes hasten the termination of 
gastric fever; if in a small number of eases they may be 
sary to expel the bile, the presence of which might irritate the 
intestines, evacuauts can only have the effect of reproducing the 
secretory irritation, which constitutes the mueons fever, 
cially when it amounts to a well characterized degree of 
mation. Nothing authorizes the opinion that gastrointestinal 
mucosities ever irritate the membrane which secretes them. 
We may admit that the bile poured by the irritated liver into 
the intestines sometimes irritates th- 

of the gastric membrane, should no more irritate this membrane 
than the nasal mucus irritates the pituitary membrane in coryza. 



MUCOUS FEVER. 157 

To diminish the gastro-intestinal irritation, to solicit the ac- 
tion of the skin, to employ derivatives which act upon this tis- 
sue, and, when the encephalon or the lungs are affected to an 
alarming degree, to resort to venesection if the circulation be 
greatly accelerated: such are the indications in mucous fever. 

When the signs of gastro-intestinal irritation are well marked, 
we must resort to the means which have been pointed out in the 
treatment of gastric fever, with the exception of very slight 
modifications. 

Whatever be the intensity of the mucous symptoms, we must 
prescribe diet, warm drinks, acidulated and edulcorated, rather 
than mucilaginous drinks, acidulated lavements and emollient 
fomentations to the abdomen. 

Whenever the irritation is intense, we must have recourse to 
leeches, but in general we should not apply a great number: 1st, 
because the subject is not generally plethoric; 2dly, because it is 
often necessary to repeat the depletion on account of the frequent 
exacerbations of irritation; 3dly, because gastro-enteritis with mu- 
cous turgescence or with an abundant secretion of mucosities, is 
less intense than that which manifests itself by signs of gastric 
fever without mucous symptoms: 4thly, because experience de- 
monstrates that in mucous fever, the sudden termination of the 
irritation is seldom obtained by a considerable loss of blood. 

When gastric irritation occasions only phenomena of little 
prominence, and does not determine any considerable accelera 
tion of the circulatory movement, we must not on this account 
conclude that it does not exist, but only that it is slight, that ir- 
ritation of the encephalon is sometimes associated with it, or 
that in this particular case, the sympathies are not easily brought 
into play. 

When, under the influence of diet, of the drinks which I have 
pointed out, or even very hot, aqueous drinks, rendered slightly 
aromatic by the addition of elder flowers, orange leaves, or any 
similar vegetable product, the gastric irritation is observed to 
diminish, its secretion to cease, and a favourable sur-excitation 
of the skin to manifest itself, this derivation must be kept up by 
the transient application of rubefacients to the latter tissue. 
But their action should be watched, for they increase the gas- 
tric irritation when they do not remove it; the part whichh iws 



158 PHYSIOLOGICAL PYRETOLOGY. 

they have been in contact must then be covered with emollient 
cataplasms. 

"We often obtain the cure of the disease by these very simple 
means, and without having recourse to the abstraction of blood. 
Nevertheless, Sarcone assures us that in the epidemic rheumatic 
fever of Naples, blood-letting, fearlessly and promptly practised 
during the violence of the paroxysm, and repeated with prudence 
on the second and third attack, was the first and most certain of 
all the remedies; that those of his brethren who confined them- 
selves to the prescription of whey and water, saw their patients 
recover very slowly, and observed the disease sometimes termi- 
nating in arthritis or rheumatism. He kept the bowels open 
with a solution of a few drams of neutral salts, with a decoction 
of barley, of mallows, with whey and emollient lavements. " It 
cannot be expressed," he remarks, " how very useful was the ab- 
straction of blood at the proper period; nor can we explain," says 
.he, " the inutility of every other remedy when this measure was 
omitted." 

After having reported the autopsic examination of an indi- 
vidual who had fallen a victim to a malignant, inflammatory and 
petechial mucous fever, Rcederer says that the employment of a 
resolvent and emollient antiphlogistic method would probably 
have saved this patient as readily as it had done many others at- 
tacked with disease nearly the same. Hitherto it has been thought 
that a salutary derivation might be caused by an emetic, which 
does in reality sometimes produc.e happy effects. 

But since less dangerous means may succeed, why not prefer 
the latter? It is true that during the operation of an emetic, the 
skin becomes hot and red, and is covered with perspiration : it is 
only in this manner that this remedy can prove useful; but it 
actively irritates the stomach. If it sometimes causes the disap- 
pearance of the mucous symptoms, it increases the intensity of 
the symptoms proper to irritation, which afterwards, pursues a 
more rapid course, and is attended with more danger to the pa- 
tient; or it persists for a longer time than it would have done, 
had the disturbing treatment not been resorted to. I do not 
dispute the small number of cases in which an almost sudden 
cure has followed the employment of an emetic; but it may be 
asked were these in reality cases of mucous fevers, occasioned 



MUCOUS FEVER. 159 

by a constitutional predisposition and powerful occasional 

causes. 

When, after having applied leeches to the epigastrium, the 
tongue becomes mucous and white at its edges, and at its point, 
if it becomes more and more loaded, if there remains a sense, 
of weight without any thirst or appetite, the pulse having re- 
sumed its natural standard, an emetic may be given with advan- 
tage; but we never can be certain, even in this case, that there 
will not be a renewal of all the phlegmasial phenomena. 

When mucous fevers are the result of idiosycrasy acted upon 
by powerful epidemic or endemic causes, it often happens that 
the most appropriate treatment abridges but slightly its course; 
it, however, obviate's danger. When these diseases are prolonged, 
it is difficult and sometimes even prejudicial to restrict the pa- 
tient to an absolute diet: we may allow him gruel made with 
bread, rice, or barley, together with acid fruits, cooked and 
sweetened with sugar. 

In the case of diarrhoea, and still more of dysentery, the most 
severe diet must he insisted upon; hot mucilaginous drinks 
must be administered; the temperature of the skin must be con- 
stantly elevated by the application of heated cloths; very hot 
emollient fomentations, and cataplasms almost burning applied to 
the abdomen; eight or ten leeches must be applied to this region, 
or to the anus, and this measure must be repeated as often as the 
intensity of the symptoms requires it and the strength of the pa- 
tient permits. # 

The inflammation of the mucous membrane of the larynx is 
advantageously combatted, as well as that of the bronchia, by 
the inspiration of water in the state of vapour; the application of 
a few leeches to the sternum or to the neck is sometimes indi- 
cated. When the pleura, and particularly when the lungs are me- 
naced, we must not hesitate to bleed from the arm; the abstrac- 
tion of eight or ten ounces of blood will be sufficient, at least in 
the greater number of cases. Without losing sight of the gastro- 
intestinal irritation, we must combat the thoracic phlegmasia as 
though it were simple, paying regard to the idyosyncrasy of 
the subject and the causes which have acted upon him. 

It may happen that, in the course of the mucous fever, pros- 
tration may supervene, the patient fall into a state of hebetude, 



160 PHYSIOLOGICAL PYRETOLOGY. 

and debility pervade the whole economy. In this case, the disease 
having become more intense, dangerously assaults the cerebral 
functions, assumes the name of adynamic fever, and should be 
treated in the manner I shall indicate when describing the treat- 
ment of this fever. 

When agitating dreams, delirium and convulsive movements, 
alternating with debility, announce that the encephalon partici- 
pates in the irritation, we must resort to the means which shall 
be pointed out in the chapter on ataxic fever. 

In the great public calamities, which determine the appearance 
and propagation of typhus fever, the mucous fever often con- 
stitutes the first degree of the epidemic. 



ADYNAMIC FEVER. 161 



CHAPTER V. 



Of the •Adynamic Fever. 

The adynamic fever is the creation of modern times; it does 
not exactly represent, as has been asserted, the putrid fever of 
the ancients. They attributed many diseases, and especially a 
great number of fevers, to the putridity of the blood and the hu- 
mours; but at least they never entertained the thought of making 
the signs of the putridity, a particular fever; doubtless because 
they never thought of isolating them from all the symptoms 
which preceded and accompanied them. What the ancients did 
not do with regard to putridity, certain moderns have not hesi- 
tated to do with regard to adynamy, and their opinion still 
influences the minds of many physicians. Before the period, 
at which it was attacked by M. Broussais, good observers had 
declared the non-existence of simple adynamic fever; but this ray 
of light was not turned to advantage; indeed, it could not be, 
since the seat and nature of inflammatory, gastric, bilious and 
mucous fevers were entirely unknown: it is easy, at the present 
day, to decide this important question. 

Selle, more remarkable for erudition than for his powers of 
observation, admitted simple mucous fevers, contrary to the opi- 
nion of his predecessors — It was his classification alone which 
led him into this error. If we" refer to the work of Stoll, we 
shall no where find an account of the adynamic fever of Pinel: 
he only describes, under the name of putrid fever, all the unfa- 
vourable symptoms that show themselves during the highest de- 
gree of fevers. Cullen did not admit a species under the deno- 
mination of putrid fever, although he thought putridity might 
complicate fevers. 

21 



162 PHYSIOLOGICAL PYRETOLOGY. 

J. P. Frank, unites, under the title of nervous fever, all fe- 
vers accompanied by symptoms of prostration or of disorder 
of the nervous system. Pinel was the first who established an 
order of fevers presenting the following symptoms; viz. debili- 
ty, languor, a prostration of vital force, pulse feeble and with 
slight acceleration, stupor, vertigo, and as it were a state of in- 
toxication, impaired sight and hearing, a sort of annihilation of 
the mental powers, slight delirium, stammering or difficulty of 
articulation, involuntary passage of the fasces and urine, &c. 
Farther on, he gives, in the following terms, a general and com- 
plete description of the symptoms of adynamic fever: 

Livid colour and general debility, tongue covered with a 
greenish-yellow, brown, blackish, or even a black coating; at 
first moist, and afterwards dry and even parched; a fuliginous 
state of the gums and teeth, fetid breath, variable thirst, deglu- 
tition impossible, or, as it were, paralytic; sometimes a vomiting 
of various matters, more or less deep in colour, constipation or 
diarrhoea, frequently involuntary dejections, black and fetid; in 
some cases meteorism; pulse small, soft, slow or frequent, often 
hard, apparently developed during the first days, but passing 
suddenly to the opposite state; sometimes from the commence- 
ment, a momentary appearance of congestion of the head or chest; 
in some cases passive hemorrhage from the nose, the bronchia, 
the stomach, the intestines and the genital organs; petechias, vi- 
bices, ecchymoses, respiration natural, or accelerated, or slow; 
heat acrid to the touch, increased or diminished; dryness of the 
skin, or partial, cold, clammy or even fetid sweat; urine retained, 
passed with difficulty, or escaping involuntarily, of a citron or 
deep colour during the first stages, and towards the termination, 
turbid, with a grayish sediment; eyes red or of a yellowish green 
colour; rheumy, tearful and squinting, the aspect dull, impaired 
hearing, sight, taste and smell; frequent deprivation of the last 
two mentioned senses; dull headache, state of stupor, somno- 
lence, vertigo, frightful dreams, or taciturn delirium, slow and 
hesitating answers, indifference on the part of the patient to his 
own condition; prostration; effacement of the features and of the 
muscular prominences in general; supine position; sometimes 
suppuration of the parotid glands, followed or met by a dimi- 
nution of the symptoms; icterus; impossibility of stimulating 



ADYNAMIC FEVER. 163 

the skin and of exciting the organism, gangrene of wounds and 
in general of the parts upon whiCh the patient has lain.* 

Admitting, for a moment, the truth of this description, and 
supposing that each of the symptoms occupies its proper place, 
and that they are ohserved to occur as they have been enume- 
rated, it is proper to subject them to a physiological analysis, 
with the view of discovering whether there is not a mistake 
with regard to the importance attributed to them; in a word, 
whether they are to be referred to adynamy. 

The livid colour and general sinking, are not symptoms pe- 
culiar to debility; in all acute diseases, there is more or less 
prostration, and frequently the colour of the skin is livid, even 
in inflammation of the greatest intensity; for example, in peri- 
tonitis. 

What reason is there for supposing that a yellowish-green, 
brownish, blackish or even black coating of the tongue is a sign 
of weakness rather than a white or a yellow covering. When 
this coat, from yellow, turns to green, can so slight a change 
authorize the supposition that the patient has passed from excess 
of force to excess of debility? — The dryness and aridity of the 
tongue, and the fuliginous state of the gums and teeth, evidently" 
indicate that the mucous membrane of the intestines is in a simi- 
lar state of dryness, in consequence of the suppression of its se- 
cretory action. If this suspension be the effect of weakness, we 
must attribute to the same cause the dryness of the mouth and 
tongue, observed after rapid running, in intense angina, in gas- 
tritis resulting from the use of wine, from spirituous liquors, or 
irritating poisons. As to variable thirst, such an indication is so 
vague, that it is useless to dwell upon it. The impossibility of 
deglutition, certainly announces a want of action in the muscles 
charged with this office; but this disability is observed in apo- 
plexy; a disease which has not yet been classed with general 
diseases caused by weakness. Besides, the weakness of some 
muscles does not demonstrate that the whole organism is debili- 
tated; it only proves that the nervous system no longer provokes 
the action of these particular muscles. 

The remarks that have been made with regard to variable 

* Nosogr. Phil, tome 1, p. 173. 



I 'A 

; •■.■.-: 






- : ::. - 



L_I £ 



ADYNAMIC FEVER. 165 

It is unnecessary to discuss the black colour of the fecal dis- 
charges: Pinel, however, paid great attention, for whatever reason, 
to this circumstance. Does not this prove, that even men of the 
most enlightened intellects have a disposition to assign the first 
place to those peculiar circumstances that most strongly address 
their senses? 

It is something surprising, that meteorism of the abdomen 
should be classed among the symptoms indicating weakness. Is 
it not a symptom of peritonitis, of strangulation, of some obstruc- 
tion of the intestinal canal, of an excessive development of gas 
in the intestines, or in the cavity of the peritoneum? Now, in 
what manner can debility occasion, I do not say the dilatation 
which is the mechanical effect of the presence of the gas, but the 
production of this gas? This is what requires explanation. There 
is, perhaps, no colic or cardialgia without swelling of the sto- 
mach and intestines, and without flatulence. I am aware, that 
it is common to attribute flatulence to a weakness of the tissues 
of the cavity in which it occurs; but this is pure hypothesis: 
consequently, we see stimulants of every kind administered in 
vain with the view of obviating this symptom, which naturally 
disappears with the irritation. 

The smallness, concentration, and slowness, of the pulse, do 
not announce a general debility, since the variations of the pulse 
only indicate the variations of the action of the heart, which may 
be languid while the other organs are violently excited. It is 
thus that the pulse is small in inflammation of the peritoneum, 
slow in that of the encephalon, while no one thinks of attribut- 
ing these diseases to weakness. Every intense irritation accele- 
rates the pulse, and renders it stronger and more frequent; every 
violent irritation renders it obscure, weak, and concentrated. 
The softness of the pulse cannot be given as a sign of essential 
debility, since it is frequently observed in peripneumony, and 
in this case disappears after bleeding, and is succeeded by force 
and fulness. Pinel asserts, that, in adynamic fever, the pulse is 
also found frequent, often hard, and apparently developed, 
during the first days. Now, the pulse cannot be developed 
only in appearance; it must either possess this character, or not 
possess it: if it be developed, it announces sur-activity, and by no 
means general weakness; and this is more especially true when 



166 PHYSIOLOGICAL PYRETOLOGY. 

it is frequent and hard; for the union of these three characters, 
constitutes the most unequivocal sign of an irritation in some 
point of the organism. Consequently, the existence of weak- 
ness, of adynamy, during the whole course of the adynamic 
fever, cannot be maintained. 

Unless it be imagined that the nature of this disease may be 
different in its different periods, it must be admitted that there 
are many cases of adynamic fever, which, at least during the 
first days, are not owing to adynamy. Those who assert the 
transition, should point out the period of its occurrence, and not 
throw together in confusion the two orders of symptoms which 
characterize the two epochs of this disease. This they have not 
done, nor is it practicable. It is true, that they have said, that 
the adynamic fever sometimes succeeds the inflammatory fever, 
inflammations, the bilious and gastric and frequently the mucous 
fever; but, certainly, as long as an inflammatory fever continues, 
it must, of necessity, be inflammatory. 

Should not the slowness and softness of the pulse be attributed 
to congestion in the head or in the chest, which is sometimes 
observed from the commencement of the disease? What can 
be meant by the momentary appearance of a congestion? By 
what fatality does it happen, that the evident symptoms of irri- 
tation have been depreciated, for the sake of exalting those which 
seem to announce weakness in a less equivocal manner. I have 
heard it asserted by a practitioner, well known in the capital, 
that, on the first glance, there was a considerable resemblance 
between the state of a patient, affected with adynamic fever, and 
one suffering under acute pneumonia. He was at a loss to ex- 
plain this phenomenon, although in reality the disease was the 
same in both cases; for the remark was made during the preva- 
lence of an epidemic pneumonia, the seat and nature of which 
he had almost constantly mistaken. 

It is easily asserted, that the hemorrhages which supervene 
during adynamic fever, are passive: it is more difficult to prove 
it. They are no more passive than ail other hemorrhages. We 
must distinguish between those which occur in the commence- 
ment, and during the course of adynamic fever, from those 
which occur immediately before the fatal termination. Those 
which occur in the commencement are constantly and evidently 



ADYNAMIC FEVER. 167 

active. In answer to the denial of this assertion, I shall only say: 
you either have not observed, or you have observed but badly. 
The hemorrhages which occur in the course of adynamic fevers 
are likewise accompanied by the local signs which characterize 
active hemorrhagy; that is to say, the tissue from which the 
blood flows, is hot, tense, and swelled, although the pulse is 
small, and even the skin cold in every other part of the body. 
This is a verity which cannot be disputed. It remains then to 
determine what is the nature of the hemorrhages without signs 
of local excitement, which, it is said, have been observed in ady- 
namic fever. Now, these cases take place only at the termina- 
tion of the disease, since it is conceded by all respectable ob- 
servers, that those of other periods are active. Even those of 
the termination of adynamic fever are rarely without signs of 
excitement in the part which furnishes the blood : were it per- 
mitted, in treating of the laws of organic action, to lay down 
rules without exceptions, I would assert that these signs are al- 
ways present, even in the last agony. 

The parts from which the blood flows in their hemorrhages, 
are principally the nose, mouth, and anus: had the physicians, 
who assert the passive nature of these hemorrhages, taken the 
trouble of examining these different parts during their continu- 
ance, if, instead of taking a superficial glance, they had applied 
the finger to the part, they would have been convinced, that the 
mucous membrane of the nose, mouth, and anus, were red and 
hot, not only a short time before death, and at the moment of 
death, but also for some time after death. If they had seen, as 
1 have, the blood flow from the bites of the leeches on the epi- 
gastrium, for some minutes after death, in a patient whose abdo- 
minal region alone retained its heat, during the course of an ady- 
namic fever, attended with obstinate coldness of the extremities? 
they would have come to the conclusion that there is nothing 
more uncommon than passive hemorrhage, that is, a flow of 
blood which is not determined by an agent of impulsion, result- 
ing only from weakness of the vascular parietes, or, if the ex- 
pression be preferred, of the pores or exhalent mouths of the tis- 
sues. I have observed, in scorbutic patients, all the symptoms 
of the highest degree of adynamic fever: I have seen them pass, 
almost continually, black blood by the anus, during the last days 



168 PHYSIOLOGICAL PYRETOLOGY. 

of their lives; this blood was quite as hot as that of a man in 
health, but probably it cooled more readily. I ascertained that 
the mucous membrane of the rectum was hot and painful, a few 
moments before death, and on opening the body I found it of a 
bright red in many points, and in others gangrenous. 

The bluish ecchymoses and petechias should be attributed to 
debility of the vessels of the skin, since this tissue is really in a 
state of astheny, during the last period of adynamic fever. This 
is not the case with regard to the small red points, that are deve- 
loped on the skin, either in the commencement, or during the 
course of the disease; when this tissue, hot and acrid to the 
touch, partakes of the internal irritation. It would be absurd, 
to attribute this pungent heat, and the hurried respiration to de- 
bility. 

The coldness of the skin positively announces that it is in a 
state of astheny: but it is by no means a sign of general essen- 
tial weakness, since every thing, on the contrary, demonstrates 
that when the periphery of the body is cold, the action of the 
internal organs is increased, until the impression of the sedative 
cause, which acts upon the skin, communicates itself through 
the medium of the nervous system to the viscera, which exe- 
cute the principal vital actions. Besides, there is only coldness 
of the extremities in adynamic fever: even at the termination of 
the disease, the abdomen is hotter than during health. Had more 
attention been bestowed upon the examination of this region, 
the science of disease would have advanced with greater ra- 
pidity. 

Cold, partial, clammy, and even fetid sweat does not indi- 
cate debility, when it is observed on a hot and acrid skin: it in- 
dicates only a local weakness, when it occurs on a cold, pale sur- 
face: in this case, it likewise announces a feeble reaction of the 
tissue. In general, the skin is not cold, in a partial sweat, until 
it has continued for some time. 

Retention of urine occurs in adynamic fever, as it sometimes 
does during profound sleep, in certain persons in good health: 
this is not a sign of general weakness, nor even of weakness of 
the muscular coat of the bladder, but results from a suspension 
of the nervous action upon this coat. It is likewise a more rare 
occurrence than is thought: it must not be confounded with the 



ADYNAMIC FEVER. 169 

suppression of urine, resulting from irritation of the kidney, 
which is more common in adynamic fever. The involuntary 
discharge of urine only announces a want of resistance on the 
part of the sphincter. The grayish sediment is not a sign of 
much importance: it is sometimes observed in adynamic fever; 
it is also observed in acute diseases, evidently inflammatory. 

The increased flow of tears and the redness of the conjunc- 
tiva, rather indicate irritation, than astheny; as to the greenish 
yellow colour of this membrane, it is not a symptom peculiar to 
adynamic fever. The dull aspect, impaired sensation, the 
stupor, somnolence, ivild dreams, the sloiv answers, and the 
indifference of the patient, are owing to diminished cerebral ac- 
tion, but this does not necessarily prove that the organ is ra- 
dically weakened, since the above symptoms may arise from 
cerebral congestion, or an apoplectic state: this is an important 
distinction, since it alone can furnish a sure basis for our reme- 
dial measures. Besides, were these symptoms the result of real 
astheny of the brain, they still would not prove that the whole 
organism was involved in the debility. There may be, and 
there often is, irritation of another organ which deserves no less 
attention than the encephalon; v an irritation of which the appa- 
rent cerebral astheny is generally the effect. 

The contortion of the eyes, the delirium, and vertigo are 
not symptoms of the adynamic fever only; since they are 
classed with those of ataxic fever. I shall, therefore, not dis- 
cuss them until the latter fever be treated of. 

Icterus cannot be attributed to weakness, nor can the suppu- 
ration of the parotids, of which we shall again speak. 

The prostration, the debility of the muscular system, the 
weakness and slowness of the muscular contractions, are the 
most common of all symptoms: they are observed in almost 
every disease, in the acute, as well as in the chronic; in inflam- 
matory diseases, as well as in those which are not considered of 
this character. Whenever an intense pain is felt, these symp- 
toms manifest themselves; they accompany coryza, as well as 
pneumonia and peritonitis. In a word, whenever the vital part 
is threatened in any part of the economy, muscular action is di- 
minished: this is not astonishing, since the integrity of the mus- 
cular function is not then necessary to the conservation of life. 

22 



170 PHYSIOLOGICAL PYRETQLOGY. 

Nature, whose powers and good intentions have been too 
highly extolled, does not always adopt the best measures for the 
conservation of the individual. The fear, which danger inspires, 
destroys the power of flying. If the fear of danger, if a sen- 
sation, not of a very violent character, and, especially, an in- 
flammation of an organ, be sufficient to suspend muscular ac- 
tion, is it rational to attribute prostration to general debility, or 
even always to a debility of the brain? During a painful opera- 
tion, fainting is not an uncommon occurrence r shall it be said, 
that this is in consequence of diminished sensibility. Besides, 
admitting that prostration is always an effect of cerebral astheny, 
it would be necessary to prove that in adynamic fever, this as- 
theny is primitive: that it is only a part of the general astheny; 
in which, it is asserted, this fever consists. Now, how can it 
be asserted, that astheny of the brain is primitive, when we see 
it preceded by the signs of excitement in this organ, or some 
other, or accompanied by the symptoms of local irritation in 
some organ? If the state of the muscular apparatus furnished a 
certain criterion of the nature of diseases, they should be classi- 
fied according to the modifications presented by this apparatus 
in each of them, instead of this modification being made the dis- 
tinctive character of but a single species of fever. It cannot be 
said, that the state of this system, is the faithful index of vital 
force, or it would follow that this force was more powerful in 
Milo of Crotona, than in Voltaire. Good observers of every 
age, have remarked, that men, endowed with great muscular 
strength, succumb in acute disease, more easily than many 
others, apparently more feeble. If the nature and seat of a dis- 
ease could be determined, from the prominence of some particu- 
lar symptoms, there would be no reason why each physician 
should not choose, among the symptoms of a disease, those 
which are referrible to some particular organ, to some particular 
morbid condition, and, upon this foundation, build a system, 
and attribute all the phenomena of disease to a particular organ, 
or to the organism in its totality. We must, on the contrary, 
endeavour to determine the part which each organ takes in every 
species of disease, and discover the morbid modification which 
it undergoes. 

The supine position being the consequence of prostration, 



ADYNAMIC FEVER. 171 

and being observed, like the latter, in manifest inflammation of 
the pleura and peritoneum, and in many other diseases, the re- 
marks which have been made with regard to prostration are 
perfectly applicable to this symptom. 

The impossibility of producing a rubefacient effect upon the 
skin is also one of the symptoms of the last scene of violent dis- 
eases, which indicate a profound concentration, generally irre- 
mediable in the viscera, much more than astheny of the brain; 
for there is no absolute necessity of the concurrence of this or- 
gan, to enable the skin to become red under the influence of 
stimulants, since all that is necessary for the stimulation of this 
tissue, is an afflux of the blood of the capillary vessels in the 
vicinity of the point upon which they act. So that when the 
skin can no longer be excited, it is owing to the complete an- 
nihilation, or at least suspension, of the circulatory action upon 
the surface; a circumstance which does not always prove that 
it is not augmented in the interior. It is not uncommon to 
see the vital action transiently lighted up on the surface, by the 
internal administration of the mildest tonics, even when vesica- 
tory applications have been used without any effect. 

The gangrene of wounds is certainly the result of a local 
slowness of the circulatory action; but it remains to be deter- 
mined whether, in adynamic fever, this slowness be the conse- 
quence of a primitive astheny of the circulatory system, or of 
an inflammation which destroys the activity of the system. 
Gangrene of the parts of the body upon which the patient lies, 
never occurs except after an inflammation of the same parts, 
resulting from compression. 

From this cursory examination of the symptoms of adynamic 
fever, the following conclusions may be drawn. 

1st, That the principal symptoms of adynamic fever announce 
an increase of force and not weakness: 2dly, that the black eolour 
and fetor of the excrements indicate, not weakness, but inflam- 
mation; 3dly, that the symptoms, such as prostration, debility, 
malaise, obtuse state of sensation and intellect, announcing a real 
diminution of cerebral action, may nevertheless depend upon 
an irritation of this organ, or of some other organ; 4thly, that 
weakness of pulse and coldness of the extremities, indicating 
weakness of the heart, does not prove that all the organs are de- 



172 PHYSIOLOGICAL PYRETOLOGY. 

bilitated; 5thly, that the symptoms of debility, few in number, 
which are observed in adynamic fever, are not observed, except 
at the highest degree of the disease, at its decline, and especially 
near the fatal termination. It certainly is not in the phenome- 
na of the last agony, that is, in the last effort of vital action, that 
we should^ study the nature of disease: by adopting such a course 
we should attribute them all to debility; nor is it in the transi- 
tion from a state of disease to that of convalescence, for, in this 
case, there are signs of weakness even after the best characte- 
rized phlegmasia?; 6thly, finally, the attentive observer perceives 
that in adynamic fever the action of certain organs only is se- 
condarily depressed, while the action of many others is, on the 
contrary, primitively exalted. The attempt should then be 
made to ascertain whether the sur-activity of the latter depends 
upon the weakness of the former, or whether the weakness of 
one set of organs be not the consequence of the exalted action of 
the other. Instead of making this important investigation, the 
apparent or real signs of weakness have alone been regarded ; 
and it has been laid down as a principle, that the disease is es- 
sentially adynamic. To arrive at this conclusion, founded upon 
so slight a basis, it is sufficient to substitute for the term astheny, 
employed by Brown, that of adynamy, which does not yet oc- 
cupy a very prominent place in pathology. 

Shall it be said, that if the symptoms of adynamic fever, con- 
sidered separately, do not prove that it depends alone on weak- 
ness, their union leaves no doubt upon the subject. Such an as- 
sertion certainly does not exhibit the appearance of a serious 
argument. In the science of observation, is it then a fact that 
two negatives make an affirmative? To collect the symptoms of 
local irritation, couple them with certain local symptoms of as- 
theny, and then pretend that this is the description of a disease of 
general debility, is evidently to pervert facts, and to forge a the- 
ory, devoid of consistency, because founded upon a false basis. 

Considered, then, in the symptoms which characterize it, the 
disease called by Pinel adynamic fever, is not essentially the 
consequence of depression of vital force. 

Let us now consider the action upon the organism of the 
causes of this fever, to discover whether there can be found in 
it, any thing that favours the opinion which we are combatting. 
These causes are the following: 



ADYNAMIC FEVER. 173 

A residence in low and damp places, in prisons, hospitals, 
camps, in the neighbourhood of slaughter-houses, in dissecting- 
rooms and in confined apartments, the air of which is not re- 
newed or is vitiated by emanations from matters in a state of 
putrefaction, or by the crowding together of many individuals, 
sick or in health, and especially when they are affected with ady- 
namic and ataxic fever, with gangrene, &c. ; exposure to marsh 
effluvia, especially during sleep, want of cleanliness; food com- 
posed of articles tending to putrefaction, putrid water, the abuse 
of aromatic, alkaline, and mercurial medicines; excessive evacua- 
tions, debauches, the absorption of pus, extreme fatigue, or ex- 
treme inaction, prolonged watching and study, habitual de- 
pressing moral affections, too debilitating a treatment of the 
fevers called inflammatory r , bilious, mucous, &c. 

If diminution of vital energy essentially constituted adyna- 
mic fever, all its causes would act by weakening the organism; yet 
among the causes are found, residence in prisons and camps, in- 
action, and depressing moral affections, causes already classed 
among those of gastric fever, which, according to Pinel, depends 
upon irritation; we found a residence in marshy places, in cold 
and damp countries, want of cleanliness, the use of damaged pro- 
visions and of bad water, the abuse of venery, prolonged watching 
and study, on a former occasion, enumerated amongst the causes of 
the mucous fever, which, according to the same author, likewise 
depend upon an irritation, have the same causes, they debilitate 
at one time, and at another irritate. We should at least be told 
under what circumstances this may occur. Pinel, it is true, ad- 
mits a singular mixture of strength and weakness in the mucous 
fever: but still this is not what constitutes adynamy; for, accord- 
ing to him, there is an adynamic mucous fever. 

Humid cold does not weaken the whole organism: when it is 
of little intensity and the circulation is very active, the subject 
can very well resist the influence of cold and the humidity. If 
the skin becomes cold, it soon regains its warmth. The asthenic 
action of cold and humidity upon the skin is the indirect cause 
of an increased action of the heart: this is evinced by daily 
observation. But when cold and humidity act permanently, all 
the organs near the surface fall into a state of langour, which 
state readily occurs in a subject whose circulation is feeble; but 



174 PHYSIOLOGICAL PYRETOLOGY, 

the debility is only external. If this union of cold and dampness 
acts strongly, the action of the heart becomes exalted, the circula- 
tion is accelerated, the lungs redouble their action, the mucous 
membranes become irritated, in one or more points, or almost 
throughout their whole extent: the encephalon participates in this 
condition, but it experiences in a higher degree than any of the 
other viscera, the transient sedative effect of the cold transmitted 
to it by the nerves: in this case are seen the best characterized 
signs of the mucous fever. If the subject was previously in a 
languid condition, the symptoms of the irritation of the mucous 
membranes and heart are obscure, scarcely appreciable. Should 
this irritation cease, or even should its symptoms diminish 
promptly, the phenomena of languor in the organs placed direct- 
ly under the influence of the brain becomes more prominent, and 
the mucous fever assumes the name of adynamic mucous fever. 
because it is supposed that general weakness has supervened upon 
the irritation specially fixed in the gastro-intestinal mucous mem- 
brane, or has been substituted for it; consequently, adynamy, in 
this case, is not the direct effect of cold and humidity. To have 
observed in the hospital the numerous victims of the German 
wars is sufficient to produce the conviction that these causes never 
directly produce adynamy. 

Can the deleterious effluvia emanating from the bodies of per- 
sons crowded together in confined apartments, and especially, 
from patients under these circumstances, and from animal and 
vegetable matters in a state of putrefaction, directly occasion 
weakness, and particularly general weakness? 

These emanations, in the first place, act only on the skin and 
the mucous membrane of the respiratory or digestive passages; 
their influence, therefore, of whatever nature, should be at first 
eonfmed to some of these parts; it is, consequently, always pri- 
mitively local. We must distinguish between those emana- 
tions which affect the sense of smell, and those which do not 
affect it: the former sensibly irritate the conjunctiva, the na- 
sal membrane, those of the throat, the pharynx and larynx: 
they provoke tears, sneezing, a sensation of pricking in the 
throat and cough: who can assert that these emanations weaken 
the vital action of those parts ! Now, if they irritate these, are 
we not authorized to conclude, in the actual state of science, 



ADYNAMIC FEVER. 175 

that they equally irritate the other parts, which, possessed of 
less excitability, or rather, less intimately connected with the 
brain, do not transmit to it the impressions made upon them by 
these emanations. As to inodorous emanations, they are so, be- 
cause they are less abundant, less compact, if we may use the 
expression, or, because they are really devoid of the power of 
exciting sensations in the parts of the organism, with which they 
are in contact. If we judge of their action by that of those 
which affect the smell, if we consider that they occasion the same 
diseases as the latter, and the same organic changes, we shall 
conclude that every deleterious emanation acts primarily by ir- 
ritating the tissue which receives it. 

Yet, as it behooves us to guard against the seductions of ana- 
logy, we must call to mind the cases in which the vital action 
ceases suddenly or nearly so, under the influence of the emana- 
tions of which we are treating. What takes place on these occa- 
sions? To this question we can give no answer. We need not here 
inquire whether the deadly cause acts by irritating or by debili- 
tating; that it has acted, is all we either know, or can know. 
Post mortem examination alone furnishes some light — the traces 
of cerebral congestion are generally detected. This case, which 
is but little known, has no direct relation to the adynamic fever ? 
in which we never witness so suddenly a fatal termination. 

When this fever arises under the influence of deleterious ema- 
tions, symptoms of gastric, bronchial, or gastro-bronchial irrita- 
tion generally precede or accompany the symptoms of prostra- 
tion: the cases in which the latter manifest themselves primi- 
tively, are so uncommon, that it is with difficulty that a few ex- 
amples of this kind have been collected, the paucity of which 
tends to disprove the opinions of the authors who have reported 
them. When symptoms of prostration show themselves in the 
first place, those of gastro-enteritis do not fail to manifest them- 
selves in a short time. When gastro-enteritis, with or without 
bilious symptoms, appears first, gastric fevers take the name of 
gastro-adynamic, or simply that of adynamic, when the symp- 
toms of gastro-enteritis cease or are but slightly perceived. 

Deleterious emanations, then, do not determine the adyna- 
mic fever, except by irritating the gastro-intestinal mucous mem- 
brane or the bronchial mucous membrane, or both together. It 



176 PHYSIOLOGICAL PYRETOLOGY. 

be admitted that many of them commence by debilitating 

the surface with which they are in contact, after the manner of 

: but it must be recognised that this debilitation is followed 

a irritation, more or less intense, of the digestive passages 

or of the bronchial membrane. 

Putrid aliments and corrupted water evidently irritate the di- 
gestive mucous membrane ; this is also the case with distilled li- 
quors, aromatics, alkalines, and mercurials. When advnamic 
fever develops itself under the influence of these morbihc agents, 
it is always preceded by the signs of gastro-enteritis, with or 
without bilious symptoms, which continues with the symptoms 
of prostration, until the happy or fatal termination. What is 
called the gastro-adynamic complication is then evident. 

Do deleterious emanations, putrid aliments, alcoholic liquors 
and other agents, which provoke gastro-enteritis, determine the 
adynamic symptoms by transporting their molecules to the 
heart or brain, or only by the irritation which they occasion in 
the mucous membranes? The conveyance of molecules to these 
viscera, not having been rigorously demonstrated, cannot be ad- 
mitted and no pathologic or therapeutic principle can be esta- 
blished upon a mere presumption. It is better to leave a chasm 
in the science than to supply the deficiency by error, or, what 
is little better, by a supposition. 

Quarin distinguishes five kinds of putrid fever: 

The first, complicated with inflammation, characterized by 
hardness of the pulse, redness of the face, turgescence of the 
veins, in addition to the symptoms of putridity, and occurring 
in sanguine persons of luxurious habits, addicted to spirituous li- 
quors, or in those, who at the commencement of the disease 
have sought to elevate their vital force by the use of wine and 
aromatic drinks 

The second, characterized by a pulse which is not very weak, 
moderate prostration, an aspect less pale and clayey, by bitter- 
ness of the mouth, a sense of oppression at the epigastrium and 
fetid eructations; " the putrid matter," he says, " is entirely 
in the primas viae:'' this variety is observed in subjects who have 
eaten largely of putrid meat or fish; 

The third, characterized by the weakness, quickness, and ine- 



ADYNAMIC FEVER. 177 

quality of the pulse; copious sweats, fetid urine, and epigastric 
oppression; the focus of putridity is, in this case, also in the 
primae viae, but the putrid principle has passed into the blood. 

The fourth presents the following characters; viz. feeble and 
accelerated pulse, great prostration, copious sweats, frequent 
watery dejections, livid tongue, pale and ghastly countenance, 
obscure vision, petechias, tremors; want of appetite, the nausea 
and vomiting less than in the preceding case; these phenomena 
occur, when the putrid matter derived from contagion, from an 
epidemic constitution, or from the use of putrid water, affects 
primarily, — says Quarin, the mass of blood, from which it af- 
terwards separates, to throw itself upon the primae viae. 

Finally, in the fifth variety, an inflammation develops itself; 
the putrid matter inflames and corrodes the primae viae, the pulse 
is quick, small, sub-renitent, and gives to the fingers the sensa- 
tion of a wire passing along the artery; the tongue is very dry, 
the cheeks red ; delirium, meteorism; convulsions and hiccough 
supervene; drinks, medicines and every liquid are thrown up; 
an ichorous diarrhoea occurs, and death soon closes the scene. 
This exposition is remarkable for the fact, that the affection, 
whether primitive or secondary of the digestive passages, and 
finally, the inflammation of these parts, in putrid fever, are for- 
mally recognised; but it is made subordinate to a matter fur- 
nished by the food, and introduced by the primae viae into the 
blood, or derived from the air, from water, introduced into the 
circulation, and by it thrown upon the primae viae. This theory 
was in keeping with the ideas that prevailed at that time, with 
regard to venous absorption. Since the absorbent faculty of these 
vessels has been demonstrated, it is natural that new experiments 
on animals should be instituted, with a view to determine the 
influence, on the economy, of putrid matters introduced direct- 
ly into the veins. This has been done by J. B. Gaspard, who 
has derived the following results from his experiments: 

Pus, introduced into the veins, in a small quantity, may circu- 
late in them without causing death, provided, that after having 
determined a considerable functional derangement, it be expelled 
from the economy by means of some critical excretion, especial- 
ly of the urine and fecal matters; but, introduced in small quan- 
tities, several times in succession, it ultimately causes death. It 

23 



178 PHYSIOLOGICAL PYRETOLOGY. 

determines death more quickly when injected in large doses; it 
then causes diverse grave phlegmasia?, carditis, peripneumonia, 
dysentery, &c. The presence of putrid fluids, animal or vegetable, 
introduced into the circulation, either by means of venous in- 
jection or serous absorption, determines an inflammation, often 
accompanied by hemorrhage, of the mucous membrane of the 
intestinal canal; putrid vegetable matter is the least active: am- 
monia, dissolved in water, causes inflammation of the intestines 
without hemorrhage. 

M. Majendie, has laid it down as incontrovertible, that the 
black vomit and dejections were evidently the effect of an alte- 
ration of the blood, caused by the introduction of putrid matters 
into the circulation, and he declares that the results obtained by 
M. Gaspard, are perfectly correct; but the results of his own ex- 
periments prove that different kinds of putrid animal substances 
have not the same effect; the muscles of the herbivorous ani- 
mals, are not, under these circumstances, so deleterious as those 
of carnivorous animals: water tainted with putrid oysters, does 
not produce very violent effects; the most deleterious is that 
which is tainted with putrid fish. These fluids, when introduced, 
even in large quantities, into the stomach and intestines, produce 
no injurious effects. Injected into the bronchia, they produce 
consequences of a more serious nature than when introduced di- 
rectly into the veins. 

It results, from these experiments, that gastro-intestinal inflam- 
mation is one of the most constant effects of the presence of 
putrid liquids in the blood; but that this phlegmasia is not the 
only one they may occasion, since we observe the occurrence of 
those of the lungs and the heart. 

It remains to be determined, whether the fluids, the effluvia, 
the miasmata, in a word, the putrid emanations, produced the 
same effect. Some experiments of M. Majendie, go to establish 
the fact, that the prolonged respiration of these emanations pro- 
duces death, but in a slow manner^ inflammation only occurs in 
the intestinal mucous membrane, and is of little intensity. 

M. Gaspard asserts, that the putrid liquid, injected into the 
veins, inflames the columnar earner of the heart, and the val- 
vule conniventes of the intestinal canal. To prove that there 
is. a real absorption of putrid matter in a state of disease, as oc- 



ADYNAMIC FEVER. 179 

curs in the experiments, he cites the case of the inoculation of 
epizootic dysentery, attended with pustula maligna, by means 
of pieces of woollen cloth, steeped in the humours of the dis- 
eased animals, and introduced into the cellular tissue, by means 
of a seton, or into wounds; and, likewise, the communication 
of the disease by the insufflation of the intestinal gases of dis- 
eased animals, or by the injection of their morbid fluids into the 
nostrils; or, finally, by the injection of the blood, the bile, or 
the excrementitial sanies of the dead or diseased animals. M. 
Gaspard thinks, that if the absorption of putrid matter by the 
pulmonary, gastric, and intestinal mucous surfaces be less hurtful 
than its direct introduction into the veins, it is not less real, and 
that it after a time produces the same result. 

From these facts, this physician concludes, that we must ad- 
mit a state of essential alteration of the blood, which is, espe- 
cially towards the termination, very black, viscid, and deprived 
of its plasticity and its fibrine, and escapes by a species of vas- 
cular transudation; that this state is indicated by the fetid odour 
of the breath, the urine, the sweat, and the alvine dejection, by 
meteorism of the abdomen, by the development of gas in the 
intestines, in the cellular tissue, and even in the blood, by an- 
thrax, by suppuration of the parotids, partial gangrenes, soften- 
ing of the flesh and rapid putrefaction of the bodies. He thinks, 
that this condition of the blood is sometimes a particular, spon- 
taneous, undivided, constitutional, putrid diathesis, sometimes 
the effect of the absorption of putrid substances, and sometimes 
the result of atmospheric heat. 

Certain experimentalists, who censure the hasty conjectures of 
physicians, are themselves by no means slow in drawing conclu- 
sions. Medical science with them only dates from the period 
at which they first created artificial diseases in animals; and, 
what is very remarkable, their labours have a tendency to carry 
the science back to what it was, when the organs were considered 
as pumps, retorts, and alembics. 

Whatever praise be due to MM. Gaspard and Majendie, it is 
not yet proved, that the pus injected into the veins is expelled 
with the urine and fecal matters, because its presence in these 
matters has not yet been established. 

Inflammations of the heart, of the lungs and intestines, de- 



180 PHYSIOLOGICAL PYRETOLOGY. 

termined by the introduction of pus into the veins, constitute a 
morbid state not less essential than that in which we suppose the 
blood to be. The black vomit and alvine dejections are more na- 
turally referred to inflammation of the stomach and intestines, 
which is acknowledged to exist, than to a chemical alteration of 
the blood, which chemistry has not been able to prove. It re- 
mains still to demonstrate the natural introduction of putrid 
fluids into the blood by the digestive passages, and it would like- 
wise remain to demonstrate the introduction of putrid emana- 
tions by the respiratory passages, if M. Piollet had not rendered 
it at least very probable, by respiring putrid gases, the odour of 
which was soon perceived in his urine and sweat. 

Nothing conclusive has been done to determine whether the 
miasmata are introduced into the circulation by the skin: the 
inoculation of pustula maligna and dysentery, practised on 
animals, requires to be repeated. The essential alteration of the 
blood, admitted by M. Gaspard, is observed in the experiments, 
if we may consider the presence of a foreign matter in this 
fluid as a proof of it. But the existence of this alteration has not 
been demonstrated in cases of natural disease. M. Gaspard has 
given, as signs of this state, the phenomena of gastro-intestinal 
and peritoneal inflammation. It is a gratuitous supposition that 
this state may arise spontaneously. All the phenomena which 
he points out, never occur except as a consequence of excesses of 
the table; the influence of miasmata and excessive heat does not 
determine them, except after a succulent or gross alimentation, a 
cerebral affection or a sudden chilling of the skin. The inflam- 
mation which occurs in the left, and sometimes in the right 
cavities of the heart, owing to the presence of a putrid fluid, 
shows that the phenomena which are construed into signs pe- 
culiar to an alteration of the blood, depend in a great measure 
upon carditis, and perhaps also on angiotitis of greater or less 
extent. These fluids act in the same manner as other deleterious 
fluids, vegetable or mineral, injected into the veins, which equally 
inflame the lungs, the gastro-intestinal mucous membrane, and 
doubtless, the heart also. 

The kidneys probably participate more or less in the irritation 
of the digestive passages. The presence of any irritating foreign 
matter in the blood can no more authorize the name of essential 



ADYNAMIC FEVER. 181 

alteration of the liquid, than the presence of the same matter in 
the alimentary canal can authorize the assertion of an essential 
alteration of the gastro-intestinal membrane. If the blood does, 
indeed, become altered by a mixture with putrid fluids, this 
alteration has not yet been demonstrated: for to assert that the 
blood is black and viscid after death, is to say nothing satisfac- 
tory, as this is the case after many diseases purely inflamma- 
tory: and even were this alteration demonstrated in experiments, 
it does not follow that it takes place in disease. Even admitting 
this alteration, it would only be one of the effects of the presence 
of the putrid liquids, and not the cause of the inflammation of the 
heart determined by these fluids. We may, with Quarin, at- 
tribute the inflammation of the intestinal canal to the conveyance 
of these fluids to it, with as much reason as to the alteration of 
the blood. Finally, conceding all they wish to MM. Gaspard 
and Majendie, it is proved by their own experiments that there 
is gastro-enteritis, carditis and pneumonia in the adynamic fever; 
that it is by these inflammations, and particularly by the first, 
that the greater number of patients perish in this disease; that, 
consequently, we must combat it by the remedies appropriate to 
these phlegmasia?, with the exception of the modifications relative 
to the exciting cause derived from the experience of all ages, and 
not from the experiments, certainly ingenious, of those physiolo- 



Should any one find subtleties in the objections alleged 
against the theories which have been opposed, he should not be 
surprised; for it is the property of the humoral doctrine to intro- 
duce subtleties into science, and it is for that reason we op- 
pose it. 

Want of cleanliness injures the skin, excessive evacuations 
diminish the materials of the organism, excess of venery and 
fatigue powerfully stimulate the brain, and throw it into a state 
of stupor; grief, excessive study, and prolonged watching pro- 
duce an irritation of this organ, determine an afflux towards it, of 
which diminished sensorial power is the first symptom; the skin, 
the circulatory system, and the encephalon are likewise disposed 
to feel the influence of other causes, but the irritations of these 
organs never alone determine the adynamic fever. 

The causes, then, which determine this fever are most general- 



182 PHYSIOLOGICAL PYRETOLOGY. 

]y, in the first place, those which irritate the gastro-intestinal mu- 
cous membrane, and in the second place those which tend to dimi- 
nish the functional activity of the brain. Supposing, then, that the 
analysis of the causes and symptoms of the adynamic fever can 
be carried no farther, we have already enough to convince us 
that there is nothing in this fever but a gastro-enteritis with 
astheny of the brain. We shall now inquire whether this as- 
theny be real, and whether it merits more attention than the 
gastric irritation. 

We must not conclude from the impaired action, or even from 
the complete interruption of the action of an organ, that it is nei- 
ther irritated nor inflamed: on the contrary, we witness a cessa- 
tion of function in almost all the organs when suffering from an 
irritation, a phlegmasia, or an afflux of blood. The sight, the 
hearing, the smell, the taste, and the touch itself, are destroyed, 
when their respective organs become inflamed; an intense phleg- 
masia of the lungs diminishes their influence upon the air and 
blood; the heart excessively irritated ceases to beat; the intes- 
tines do not contract when they are inflamed : in a word, the sus- 
pension, the diminution and even the abolition of a function are 
more frequently the effect of acute or chronic inflammation of 
the organ charged with its performance than of the astheny of 
this organ. Do we not in apoplexy witness the extinction of 
all the functions of relation, owing to the rapid afflux of blood 
to the part? This afflux is not attributed to weakness, except by 
persons who are ignorant of the laws of life. It may then be 
asserted, that if there be sometimes a real astheny of the brain 
in adynamic fever, there is much more frequently sympathetic 
irritation of this organ, or of its connexions; and, indeed, if the 
intellectual activity generally diminishes, the headache, delirium, 
insomnolence, contusive pains in the extremities, and the groans 
of the patient, by no means indicate a state of weakness of the 
brain. It is evident that the only reason why adynamic fever 
is referred to weakness as its cause, is the existence of muscular 
debility. 

Hitherto I have only considered this fever in a general man- 
ner, and as Pinel has described it; I shall now examine the value 
of the precursory sign which he attributes to it: I shall then 
show that in his enumeration of the symptoms of this disease he 



ADYNAMIC FEVER. 183 

has confounded three distinct states, which should be distin- 
guished. 

Now, if we cast a glance over the precursory signs of adyna- 
mic fever, we shall see that every thing in them announces not 
so much weakness as irritation of important organs. These signs 
are, 1st, derangement of digestion: this symptom indicates a le- 
sion of the stomach, most frequently an irritation of this viscus, 
never a general debility; 2ndly, an obtuse cephalalgy; however 
obtuse be the cephalalgy, it is always indicative of a state of suf- 
fering, arising from irritation, and not from weakness of the 
brain; 3dly, obstinate somnolence; another sign of cerebral suffer- 
ing; 4thly, a state of stupor; we should here recall what has been 
said of this symptom; 5thly, undefined pains in the limbs, the 
usual precursory sign of most diseases, whatever be their seat or 
nature; besides, no pain is the effect of weakness; 6thly, sponta- 
neous lassitude; this symptom is likewise observed at the com- 
mencement of all diseases, and especially of internal inflamma- 
mation; 7thly, a sense of general heaviness; this precursory 
symptom is common to the adynamic fever, and a state of ple- 
thora as well as to synocha: nothing can, therefore, be inferred 
from it with regard to the nature of the first of these fevers. 

Since then a detailed examination of the symptoms, the causes, 
and precursory signs of adynamic fever, shows that a number of 
organs are sur-excited in this disease; that the circulatory move- 
ment, the cerebral functions, and locomotion alone become lan- 
guid or are suspended, and this only at the highest degree, or 
rather at the last period of the disease; that in the commencement 
of adynamic fever there is always an augmentation of vital ac- 
tion in the principal organs, a fact which excludes the idea of a 
radical and especially of a general weakness; it must be acknow- 
ledged that this fever is not primitively owing to weakness. If 
we farther consider that in the midst of the symptom of debility > 
the symptoms of irritation continue to show themselves in the 
plurality of cases, and this generally until the last instant of life, 
we shall be compelled to conclude that the adynamic fever is 
never a disease essentially asthenic, as has been asserted. It 
then remains to decide whether weakness occurs in the decline 
of the disease. Now, observation decides that it does not occur 
until after the fever has lost all the characters which have given 



184 PHYSIOLOGICAL PYRETOLOGY. 

rise to the term adynamia; that is, until convalescence or the last 
agony. 

I might now pass on to an exposition of the symptoms detect- 
ed on post mortem examination; but before entering upon the 
consideration of this incontrovertible proof, I deem it proper to 
observe that if the existence of adynamic fever continues to be 
admitted, we must admit at least three varieties of it. The first, 
to which I must be permitted to assign the name of the dry ady- 
namic fever, is that which manifests itself at the commencement, 
during the course, or at the decline of any inflammation, except 
that of the digestive passages^ and that without being the pro- 
duct of gastro-enteritis, as it is sometimes observed in inflamma- 
tion of the lungs, the pleura, the peritonium, the bladder, the 
uterus, the heart, and perhaps the blood vessels, &c, and in the 
case of wounds, which, owing to prolonged and profuse suppu- 
ration, occasion death without producing gastro-enteritis. This 
variety presents neither gastric fever nor fetid excretions of any 
kind; the sputa alone sometimes derive a peculiar character from 
the state of the lungs. Such is the adynamic fever which some- 
times complicates the inflammatory fever, not dependent upon 
gastro-enteritis, or any phlegmasia; or which, in language used 
even at the present day, masks these diseases Inflammatory 
fever, simulating the adynamic; false adynamic fever. 

The second variety, which may bewailed humid or putrid 7 
if the term be preferred, is the highest degree, and is sometimes 
seen at the commencement of intense gastro-enteritis,. and is cha- 
racterized by diarrhcea, vomiting, fetid dejections, sweat, and 
urine. It constitutes the putrid synocha of the Galenists. This 
variety also supervenes in the course of many phlegmasia?, when 
they are joined with an intense gastro-enteritis. This species 
is what is sometimes designated by the name of gastro-bilioso- 
adynamic or mucoso-adynamic fever, primitive or secondary. 
Finally, the third variety is that which they say occurs without 
any preceding or concomitant sign of unequivocal irritation in 
any of the organs constituting the essential adynamic fever of 
certain authors, who still believe that such exist, although their 
infrequency is no longer disputed. 

But the dry adynamic fever is evidently the effect only of an 
oppression of the heart and brain, resulting from some phleg- 



ADYNAMIC FEVER. 185 

masia of great intensity, or supervening in a subject badly nou- 
rished or predisposed to cerebral affections, by grief or study. 
The humid adynamic fever is a group of symptoms of pros- 
tration, the effect of a primitive or secondary gastro-enteritis, 
developed under analogous circumstances. Finally, the es- 
sential adynamic fever is referrible to one or other of the two 
preceding varieties, in which the symptoms of irritation, consti- 
tuting the disease, are misunderstood: 1st, because the patients 
are brought to the hospital at too late a period, and it is impos- 
sible to obtain any information with regard to them; 2ndly, be- 
cause prostration, stupor and immobility supervene so rapidly, 
or are so intense, that they do not permit the signs of irritation 
to be distinguished. There are, perhaps, cases in which the ir- 
ritation of the organ primitively affected ceases, although the 
morbid state of the heart and brain which gives rise to the lan- 
guor of the circulatory movement of the intellectual functions, 
and the muscular motion, continues. If this sometimes occurs, 
it certainly is but seldom. If we cannot altogether refuse to ad- 
mit such a case, it must be considered only as a probable occur- 
rence, and not as a demonstrated fact. Opinions the most op- 
posite are thus reconciled without the danger of any practical 
error, provided we recognise, 1st, that the infrequency of these 
cases make it necessary that they be regarded as forming an ex- 
ception, and not a rule; 2ndly, that in these cases the adynamic 
symptoms are also in consequence of an irritation; 3dly, that this 
prolongation of the symptoms of languor in the circulation, the 
cerebral functions and the muscular movements, is not observed, 
except after a continuance generally very protracted, and a gra- 
dual diminution of the primitive irritation; 4thly, that in this 
state of things the slightest cause may renew the irritation and 
augment the symptoms which we wish to dissipate, and that 
these symptoms usually cease spontaneously, w T hen the irritation 
is not reproduced by inappropriate treatment, provided the pri- 
mitive irritation has not been exceedingly intense; finally, that 
it is better to abandon the patient to nature, than to endeavour to 
obviate the stupor by stimulating the organ which has been and 
perhaps still is in a state of irritation, notwithstanding all appear- 
ances to the contrary. 

From these observations the following conclusions may, I 

24 



186 PHYSIOLOGICAL PYRErTOLOGY. 

think, be deduced: 1st, that the group of symptoms, to which the 
name of adynamic fever has been assigned, is almost always the 
most intense degree of gastric or mucous fever, sometimes of 
synocha; that is to say, most frequently of a primitive or secon- 
dary gastroenteritis, and sometimes of some other primitive ir- 
ritation, complicated or not with gastro-enteritis; 2dly, that 
when the irritation, which occasions the symptoms termed ady- 
namic, has ceased in the organ primitively affected, if the mor- 
bid state which it has occasioned sympatheticallv in the ence- 
phalon or in the heart sometimes continues, it is no longer the 
adynamic fever, such as Pinel has described it: it is a state purely 
secondary, which has now become idiopathic: 3dly, that facts 
do not authorize us to consider this condition as an asthenic af- 
fection; but that analogy, on the contrary, would incline us to 
class it among irritations of this viscus, although there certainly 
are still important researches to be made on this point. 

These principles being laid down, every thing becomes clear 
in the history of adynamic fever. 

Pinel asserts, that it continues from seven to forty days: that 
when it terminates favourably, there supervenes a troubled urine 
with a grayish sediment, a general warm sweat, dejections of 
homogeneous matters, resembling lees of wine, sometimes in- 
flammations of the parotid glands, and abscesses. In all this, 
there is nothing which may not occur in the fevers which have 
already been treated of. The slight gastro-enteritis which gives 
rise to inflammatory fever of little intensity, in infants, often 
ceases after the appearance of glandular tumours of the sub-max- 
illary region or of the groin, and sometimes of the testicle, or it 
sometimes continues after the appearance of these tumours. It 
is far from true that inflammation of the parotids always an- 
nounces the favourable termination of adynamic fever: the con- 
trary is often the case. This sign, to be favourable, must coin- 
cide with the termination of other symptoms. The same is the 
case with all the signs; none of them have any value when iso- 
lated. Deafness, which occurs at an advanced period, is regarded 
as a favourable symptom, but it has not been considered that it 
never supervenes, or rather, that it is never observed, except 
when the patient has recovered sensation and motion: that is, af- 
ter the commencement of convalescence: at this period, favoura- 
ble signs are not wanting. 



ADYNAMIC FEVER. 187 

The favourable symptoms have exercised the sagacity of Hip- 
pocrates, and all semeiologists. Among these phenomena, some 
are common to most of the diseases which terminate in death; 
others belong especially to fatal gastro-enteritis. The former 
are, impossibility of deglutition and the falling of the drinks into 
the oesophagus, as if it were a lifeless tube; smallness, weakness, 
irregularity and intermission of pulse; the respiration accele- 
rated, difficult, and short, and the breath cold, the sweat partial, 
clammy and cold, like the skin; a black sediment of the urine; 
substtfttts tendinum, perfect insensibility, want of reaction in 
the skin, notwithstanding the application of vesicatories and other 
stimulants. The latter are, the continuance of vomiting and di- 
arrhoea; a discharge, by the mouth, anus, or nostrils, of black 
matters, exhaling a cadaverous odour, or of black and liquid 
blood; meteorism of the abdomen. None of these phenomena, 
considered alone, indicate death, although they should occasion 
the greatest solicitude; but their union banishes all well founded 
hope. 

The reader must perceive, that in giving a description of the 
adynamic fever, and in investigating its nature and seat, I have 
retraced the history of the synochal, gastric and mucous fevers, 
which terminate fatally after a remarkable languor of the circu- 
lation, the intellectual functions and locomotion. Doubtless, it 
will be granted that when these diseases are epidemic, their na- 
ture and seat are the same as when they are sporadic; epidemic 
adynamic fevers having received the name of typhus, they shall 
be made the subject of one of the following chapters. Let us 
now see whether post mortem examination confirms what has 
been said with regard to the nature and seat of adynamic fever. 

The lesions detected after the fatal termination of adynamic 
fever, are by Pinel reduced to a small compass: "Autopsy," 
says he, " furnishes variable results: sometimes no lesion of im- 
portance is found in the organs; at other times there is a deep 
redness of most of the mucous membranes, or a serous effusion 
into the ventricles of the brain." 

It is certainly surprising, that a physician, who has so often 
recommended the study of pathological anatomy, should think 
himself at liberty to dismiss so lightly the consideration of these 
lesions: doubtless, he found them too insignificant, and too com- 



188 PHYSIOLOGICAL PYRETOLOGY. 

mon for serious attention; besides, every local lesion warred with 
his favourite opinions, in regard to the seat of fever. These ma- 
ladies being general, what light could lesions of so little extent 
and profundity throw upon their nature? These lesions, on the 
contrary, assume great importance, when we cease to consider 
fevers as invading the whole organism: when we are convinced 
that they are all derived from a lesion, primitively local. In 
the preceding chapter, we have found that Roederer and Wag- 
ler, Sarcone and Cotugno, found in the bodies of those who fell 
victims to mucous fever, unequivocal marks of inflammation, not, 
however, without the previous existence of adynamic or ataxic 
symptoms. If I have not given in this chapter a relation of their 
anatomical researches, it is because they appear to establish the 
transition of fevers, (which, according to nosologists, are not fa- 
tal,) into those which, unfortunately, are generally mortal. 
Since the gastric fever becomes adynamic, more frequently, and 
more manifestly, than the mucous fever, post mortem examina- 
tions in this fever, have not been reported, except under the 
name of adynamic or ataxic fever. 

Numerous examinations have convinced M. Prost, that after 
the fatal termination of adynamic fevers, there are always found 
traces of inflammation of the gastro-intestinal mucous mem- 
brane. M. Broussais, who originally was not of this opinion, 
has at last convinced himself that it is founded upon the obser- 
vation of facts. I have witnessed his researches, for more than 
a year, at the hospital of Val de Grace; I have likewise made 
similar researches at the hospital of Gros-Caillou. During the 
first years of my medical studies, I opened a great number of 
bodies under the direction of Cognier, a laborious and modest 
inquirer, who faithfully sought the traces of disease in the organs, 
without a view to confirm or combat any system. I proceed now 
to give the result of my studies, firmly believing that all physi- 
cians may convince themselves of their accuracy. 

The lesions found on dissection vary according as the inflam- 
mation which constitutes the adynamic fever, has been confined 
to the stomach and intestines,' or has involved other organs. 
Thus, in the variety which has been denominated dry adyna- 
mic fever, we must generally discover the known traces of the 
phlegmasia of the brain, the bronchia, the lungs, the pleura, the 



ADYNAMIC FEVER. 189 

larynx, the liver, the uterus, the kidneys, the bladder, the cel- 
lular tissue, the abdomen or the limbs, &c. The digestive pas- 
sages do not exhibit morbid traces, except in a slight degree. In 
the variety to which I have given the name of humid ady- 
namic fever, whether it has, or has not, been accompanied by 
one of the phlegmasia? I have just pointed out, there is almost 
always unequivocal, and sometimes very profound, traces of gas- 
tritis, of enteritis, or of gastro-enteritis. At the termination of 
essential adynamic fever, that is to say, if that which appears 
to be without any signs of irritation, we still more frequently 
find traces of the same character, which nothing indicated during 
life. Finally, there are cases very limited in number, in which 
we detect after death no appreciable lesion in any organ what- 
ever, no matter of what character may have been the symptoms: 
but this seldom occurs in the humid or putrid variety. It is 
only when the disease has been promptly mortal, or when it has 
continued for a long time, when death has occurred before the 
complete development of the signs of irritation, or a long time 
after their cessation, especially if they have been of short con- 
tinuance, that we find no traces of inflammation. 

It is then in the stomach and intestines that we find the most 
remarkable and most constant alterations, at the termination 
of adynamic fever; but to detect these alterations, we must 
not limit ourselves to a superficial glance at the intestinal mass, 
without disturbing its convolutions, since the organic changes 
generally occur in the mucous coat, while the peritoneal re- 
mains sound. The declamations of physicians, who still please 
themselves by repeating that dissection throws no light upon the 
nature and seat of adynamic fever, prove only that they have 
examined very slightly the intestinal canal, or that they have 
examined, and wanted capacity to draw conclusions from their 
examinations, or, finally, that they are total strangers to any re- 
searches of this kind. It has been reserved for the present age 
to witness the presumption of physicians deciding upon the 
utility or inconveniences of post mortem examinations, in the in- 
vestigation of the nature and seat of disease, without ever having 
opened a single body. A desire to flatter the errors in vogue, 
among certain persons, has induced them to venture beyond the 
narrow limits of their knowledge. 



190 PHYSIOLOGICAL PYRETOLOGY. 

On opening the abdomen, the stomach and intestines frequent- 
ly appear quite sound: at other times, they present a bluish tinge 
with a kind of transparency; in other cases, we obserye spots, 
more or less numerous, brown, blackish, or eyen absolutely 
black, spread over the surface. Sometimes the stomach and in- 
testines are distended by gases: at other times, the stomach is 
contracted, and reduced to the ordinary size of the intestine. 

If we lay open the whole digestive canal, from the cardia to 
the anus, and remove the mucous, fecal, and other matters which 
they contain, the mucous membrane is almost always found in- 
jected, dotted with red points, covered with patches of a clear 
or deep red, purple, violet, bluish, brown, blackish, or of a slate - 
coloured gray: this membrane is thickened, softened, ulcerated; 
its surface displays small scattered spots or cicatrices. 

The injection of the mucous membrane of the digestive pas- 
sages, is recognised by numerous striae, disposed in a reticulated 
manner, and evidently formed by the little vessels of this mem- 
brane, dilated and still filled with blood. These striae are more 
or less numerous and crowded, and are sometimes visible exter- 
nally: they may be compared to those which appear upon the 
conjunctiva, in ophthalmia; and better still to those observed 
upon the membrane of the isthmus of the fauces, and upon the 
velum palati, in angina. These striae, which are sometimes of 
a bright and sometimes of a deep red, often extend over consi- 
derable portions of the mucous membrane of the digestive or- 
gans. 

Instead of vascular striae, there are often bright red points, 
more or less crowded together, which only occupy portions, of 
little extent, of the mucous membrane of the digestive pas- 
sages. 

These striae and points, when they are very near to each other, 
form patches, the number, extent, and form of which vary very 
much. Sometimes a ground of striae i3 not marked with these 
points. 

Besides the patches which I have just mentioned, there are 
others, in which .the injection is so complete, that we hardly dis- 
cover any distinct striae or points: their colour varies from a 
bright red to a black, such as we observe on the surface of gangre- 
nous wounds. These patches, the extent of which varies from 



ADYNAMIC FEVER. 191 

the length of a nail to that of a finger, frequently invade al- 
most the whole surface of the stomach, and the greater part of 
the small intestines. The internal memhrane of these parts is 
often red, grayish, or black, over an extent of one or more feet 

When there is but a simple injection, or points only, the mu- 
cous membrane is generally thickened; it is often so when the 
striae and points are distributed in patches, almost always when 
the patches present a uniformly red colour, and always when a 
slate-coloured gray tint is observed on them. 

When the digestive membrane presents a bluish tint, visible 
through the muscular serous and cellular membranes, as some- 
times is the case, over the whole extent, the parietes of the in- 
testines is very thin, and almost transparent: this state does not 
prevent the existence of striae, or red points over diverse points 
of its internal surface. 

If we examine with care the red, gray, or blackish .points of 
the gastro-intestinal mucous membrane, we perceive that they 
often undergo a true softening, and that they are sometimes re- 
duced to a sort of pulpy or gelatiniform substance. This altera- 
tion sometimes takes place on portions of the intestines which 
present no redness, or which are red and black only at distant 
points. There is often a black point in the centre of the soft- 
ened portions, the extent of which varies from less than a line 
to the size of a guinea, or it may be even greater: this point 
sometimes involves the whole thickness of the intestine, form- 
ing on the surface of the serous membrane the black patches 
which have been mentioned. 

The softening is sometimes very circumscribed, and the re- 
sult of its highest degree is then the formation of ulcers, pre- 
senting generally a few lines of diameter, sometimes very ex- 
tended, the edges of which are thick and perpendicular, impli- 
cating the mucous, and sometimes the muscular coat: the bottom 
of the ulcers is grayish, or whitish, like most of those occupy- 
ing the mucous membrane. These ulcers are often surrounded 
by an areola of a red colour, more or less deep: they are some- 
times observed upon the posterior, sometimes upon the anterior 
portion of the intestinal surface of the mucous membrane of the 
intestines; more frequently, about the termination of the small 
intestine, especially near the ilio-coecal valve than in the great 



192 PHYSIOLOGICAL PYRETOLOGY. 

intestine, except in the case of diarrhoea; more frequently in the 
latter than in the stomach, and more frequently in the colon 
than in the rectum. On the surface of these ulcers, or around 
them, we frequently find vegetations, sometimes large, soft or 
hard, red or blackish. 

In place of circumscribed ulcers, generally rounded, we some- 
times detect a sort of wasting of the coats of the stomach, the 
thickness of which diminishes insensibly to a point, where they 
are excessively thin and transparent, or even perforated. This 
wasting, which is always of great extent, is less frequently ob- 
served in the intestines; but it is by no means uncommon to dis- 
cover in the latter, as well as in the stomach, a circumscribed 
wasting, in the centre of which there is a perforation, such as 
might be made by a pointed instrument. Whatever may be the 
seat of the perforation, the part which it occupies is often red 
or brownish after death; at other times, it presents no remarka- 
ble discoloration. 

When perforation- takes place in any part of the canal, the 
contained fluids pass either in whole, or in part, into the cavity 
of the peritoneum, upon which are always found, in this case, 
traces of inflammation. Perforation sometimes occurs between 
two adherent pieces of intestine, so that the effusion does not oc- 
cur, the matters passing from one intestine to another by this ab- 
normal communication. 

Much has been said of the invagination of the intestines, and 
many researches remain to be made with regard to this singular 
lesion, which is not uncommon after adynamic fever: it is some- 
times found in many places, and is often very extended ; it al- 
most always consists of the inferior portion introduced into the 
superior, and is very generally accompanied by traces of in- 
flammation. 

The peritoneum generally presents traces of inflammation 
when the abdomen has been very painful to the touch. It is not 
uncommon to find diverse alterations in the portions of the me- 
sentery, which correspond to the inflamed parts of the intes- 
tines: it is often found red or retracted: this circumstance causes 
the parts of intestines which have suffered lesion, to be situated 
deeply in the abdomen, whilst the sound parts cover them, and 
are presented first to view. The mesenteric glands which are 



ADYNAMIC FEVER. 193 

in the vicinity of the inflamed parts, are often tumefied, red, and 
remittent. Bordcu,* Roedercr, Wagler,t and Sarcone, made 
this remark, which has been repeated, and the value of which 
has been proved by M. Broussais. 

The digestive cavities contain fluids more or less abundant, 
and of various aspect. There is sometimes a considerable quan- 
tity of mucosity occasionally disposed in a membraniform layer 
of greater or less extent, or in glairy masses; sometimes, though 
more rarely, a certain quantity of bile of diverse colours; finally, 
we sometimes find a blackish or grayish and serous fluid, or 
blood, black and liquid, or coagulated and grumous. The ex- 
istence of worms is not a matter of any constancy. Very often 
there are no fecal matters, every where ulcers are found when 
the patient has been upon a diet, and when lavements have been 
administered. 

Such is the summary or history of the diverse alterations de- 
tected after death in the stomach and bowels of those who suc- 
cumb with the signs of adynamic fever when the digestive tube 
has been inflamed. If to gastro-enteritis, there be joined an in- 
flammation to some other part of the organism, we most fre- 
quently find traces of the latter. If, for example, there have 
been some signs of irritation of the encephalon, if there has been 
delirium, notwithstanding the prostration,* we find the vessels of 
the brain gorged with blood, the arachnoid reddish, opaque, and 
thickened, and serosity on the surface of this membrane. If 
there has been cough, oppression, or a painful point of the thorax, 
the bronchia and pleura are red, and the pulmonary parenchy- 
ma gorged with blood. In the case of the angina, called gan- 
grenous, the mucous membrane of the pharynx presents traces 
of the most violent inflammation of which the gastro-enteritis 
has been only the extension or repetition. 

After adynamic bilious fever, the biliary ducts and the gall- 
bladder itself partake of the redness, more or less deep, of the 
gastro-duodenal mucous membrane; the liver is gorged with a 
black blood, which flows out when its tissue is divided. 

I have spoken of the lesions which are found in the bodies of 

* (Evres Completes. Paris, 1818, tome 1, p. 110. 
t De Morbo Mucoso, p. 310. 

25 



194 PHYSIOLOGICAL PYRETOLOGY. 

those who have fallen victims to the mucous fever, and there- 
fore, in general, to the adynamic mucous fever. 

When there has been suppression of urine, the kidneys are 
red, more remittent than usual, sometimes without appreciable 
alteration. The mucous membrane of the bladder is very often 
manifestly injected, dotted with red or white points, like that 
of the intestinal canal. 

The glans penis and the internal face of the labia majora, are 
in some cases of a bright red, dark or violet colour, an ap- 
pearance which indicates what is afterwards discovered on dis- 
section. 

Is it possible to discover during life the degree of inflamma- 
tion, and to foretel the kind of organic change which dissection 
will reveal in case of death, in the organ, the inflammation of 
which has given rise to the adynamic symptoms? In the present 
state of science, this question cannot be answered affirmatively, 
because researches are yet wanting with regard to the shades of 
symptoms that correspond peculiarly to each of these morbid 
changes. The difficulty of ascertaining during life the exact na- 
ture of the inflamed parts, presents one of the most serious ob- 
stacles to the direction and consequently to the success of treat- 
ment; but it must not, hence, be concluded that we are ignorant 
of the true nature of fever; for the same remark might, for a si- 
milar reason, be made in relation to peripneumonia. 

If the remarks which have just been made had been published 
at an early period of the sciences, or when they were in their 
infancy, no objections would have been raised against them. 
The cultivators of medicine would have confined themselves to 
an observation of the patients and to post mortem observation, 
with a view to discover and perfect the diagnosis and treatment 
of adynamic fever, that is to say, of the inflammatory disease 
with symptoms of apparent debility which have received tt^is 
name. But every theory which could overthrow doctrines ren- 
dered sacred by time and the authority of names justly celebrated, 
necessarily meets with opposition. The objections, however, 
which have been raised against the doctrine which has been ex- 
plained, are more remarkable for their frivolity than for strength 
of argument. 

With a view to set aside the results of pathological anatomy 



ADYNAMIC FEVER. 195 

to which we are indebted for a knowledge of the nature and seat 
of adynamic fever, some physicians persist in asserting that the 
organs, and particularly those of digestion, present no traces of 
inflammation after death, or at least that these traces are very 
uncommon; that these alterations, however common, do not dis- 
prove the existence of an essential adynamic fever; that these 
alterations are not of so serious a character that we can attribute 
to them the death of the patient; that they are compatible with 
a state of health; that they are the effects of death; that they de- 
pend upon the remora of fecal matters; that they are not owing 
to inflammation; that they are but the effects of the fever; that 
they result from the astheny under which the patients labour in 
this fever; that they are the effects of an inflammation, but of an 
inflammation essentially gangrenous or atonic;- finally, that they 
are the consequence of a true inflammation, but that this inflam- 
mation complicates and does not constitute the fever. 

We shall consider these objections, and show how little foun- 
dation they possess. 

1. The alterations which the organs, and particularly those of 
digestion, present after death from adynamic fever, have been 
denied. To deny is not to disprove a fact; it only evinces, in the 
present case, a desire to evade the consequences of this fact. How 
shall we properly answer those who deny that any thing is ob- 
served on dissection after these diseases. We can only say, that 
they have not seen, or have not wished to see. 

2. It is pretended, that these alterations occur only in a very 
limited number of cases. Were this assertion admitted, (which 
it cannot be,) still we should have to determine what must be 
thought of those cases in which the alterations are manifest, and 
thus we should so far reduce the number of essential adynamic 
fevers. 

3. Forced to concede that in at least three-fourths of the cases 
these alterations are found, some physicians admit the infrequency 
of essential and the frequency of symptomatic adynamic fever, 
while others continue to regard all these fevers as primitive. 
To the first we may answer, that the cases in which traces of in- 
flammation are found, are to those in which they are absent, as 
one to a hundred, and consequently that essential adynamic fever, 
if it exist at all, is not only rare, but excessively so; a fact which 



196 PHYSIOLOGICAL PYRETOLOGY. 

it is important to know with a view to treatment: with regard to 
the latter, it must be said that their labours can confer no benefit 
on humanity, or subserve the cause of science; that they vainly 
wish to. destroy the authority of the most frequent cases by that 
of the most uncommon; that they cite exceptions to invalidate 
a rule which these very exceptions confirm ; finally, that it is 
absurd to assert that a fact proves nothing, when it does exist, 
because it sometimes does not exist. 

4. It is asserted that the traces mentioned, of what nature 
soever they may be, are not sufficiently profound to allow us to 
refer death to the lesion as its cause; a red or a black patch or 
even a gangrenous one cannot occasion death, since the suppura- 
tion of a portion or even of almost a whole lung does not deter- 
mine it. But there is a great difference, in the danger occasioned 
by these lesions, between organs, which like the lungs are identical 
throughout their extent, and the parts of which may to a certain 
extent be vicarious to each other, and the portion of the digestive 
canal which extends from the cardia to the anus: the latter is in 
6ome sort a single organ, which, to perform properly its function 
should be sound in every part. The mucous membrane which 
lines it, resembles in this respect the mucous membrane of the 
bronchia: thus these two membranes are equally capable of oc- 
casioning death, when they are inflamed to a sufficient degree 
either to unfit them for their respective functions, or to act upon 
the brain, and to throw it into a state of suffering which consti- 
tutes the most dangerous complication. Now, if it be proved 
by the authority of the most respectable writers that croup and 
pleurisy may occasion death without leaving after them any traces 
but redness, cynanche pharyngea has destroyed great numbers in 
certain epidemics, and that without leaving any other trace than 
a redness less deep than that of health, or a gangrenous appear- 
ance of the membrane; if peripneumony itself sometimes leaves 
but a simple congestion of blood in the lung, an inflammation of 
the lining membrane of the digestive passages may equally 
exist, without leaving after it traces more palpable, even when it 
occasions death. 

Besides, it is not the injection, the red points or patches, nor 
even the gangrene discovered in the intestines, nor the traces of 
inflammation detected in the other organs, that occasion death 



ADYNAMIC FEVER. 197 

in adynamic fever. All these alterations are only the indices 
and vestiges of a formidable morbid state, which has resulted in 
an interruption of the function of the diseased organ, the disturb- 
ance or cessation of its influence upon a more important organ, or 
one equally important with itself. This slight vascular net-work 
and this large red or brownish spot are not, we are well aware, 
profound lesions of structure, but they indicate that there has 
been in this part during life an impetuous afflux of blood, redness, 
heat; in one word, a cause of pain, which the patient frequently 
does not point out, because he is unable to express his suffering 
with accuracy. These are the marks of a local and painful ex- 
cess of the nutritive action, the result of which has been the 
destruction of vitality, at first in a part, and then in the rest of 
the economy. 

Besides, how singularly constituted must that mind be, which 
denies the fatal influence of the lesion of a vital organ because this 
lesion does not involve the whole organ, and attributes death to 
organs in which no trace of disease is discovered, instead of re- 
ferring it to those in which these are found sometimes, however 
slight? 

5. These alterations are compatible, it is asserted, with a state 
of health; they have been detected in persons killed suddenly 
by mechanical causes; similar appearances have been observed 
in the intestinal canal of dogs killed for experiment: finally, such 
marks are often found after death without the previous existence 
of adynamic symptoms. The answer to all this is easy. Nothing 
directly proves that during life such alterations are borne with 
impunity. Did those, in whom they are detected after an ac- 
cidental death, experience no derangement of the digestive organs 
at about the time of their death? This is not mentioned, and yet 
it is a circumstance important to be known. These alterations are 
not inseparable from adynamy; no one asserts that they are; but 
they prove, when they occur after adynamy, that the latter was 
occasioned by the lesion of which they were the vestiges, when 
there has been during life signs of irritation of the digestive 
organs, however slight or transient they may have been: the ef- 
fect, however, of the brain more or less disposed to take on irri- 
tation is not to be disregarded as conducing to the fatal termina- 
tion. As to the redness observed in the intestinal canal of healthy 



198 PHYSIOLOGICAL PYRETOLOGY. 

dogs, what inferences with regard to man in a state of disease can 
be drawn from this? 

6. The alterations found in dead bodies after the adynamic 
fever are the effects of death, of phenomena purely post mortem, 
according to some persons: let these persons, then, explain why 
they do not class among the same phenomena the redness of the 
mucous membrane of the bronchia" and the throat, when it exists 
after death. Professor Chaussier has pointed out the manner of 
distinguishing cadaverous marks; the alterations found after the 
death of subjects affected with adynamic fever cannot without 
great ignorance be confounded with them. Besides, it is not suf- 
ficient to advance a proposition to gain its admission; and it is 
yet to be proved that the alterations which evidently announce 
a phlegmasia when they are observed after the ingestion of 
poisonous substances, are only phenomena developed after death 
when they are found in subjects who have not been poisoned. 

7. Some physicians, as a last resource, have attributed the ir- 
ritation and inflammation of the gastro-intestinal mucous mem- 
brane in adynamic fever to the contact of fecal matters, and, to 
support this chimerical notion, they maintain, contrary to all ex- 
perience, that the traces of inflammation are always found in the 
most declining part of the intestinal canal. But these traces are 
likewise observed in the stomach, where there are no fecal mat- 
ters, as well as in the small intestines, in which there are few: 
they are also observed, when there is not an atom of excrement 
an the whole intestinal tube, and, what is more, in most cases in 
whieh there has been diarrhoea. And, when the intestines con- 
tain such matters, is it not ridiculous to assert that they injure 
ronly the declining part of these organs, since these organs close- 
ly embrace their contents? This objection, therefore, does not 
■merit serious consideration. 

8. For the sake of depreciating the importance of the alterations 
observed after adynamic fever, it has been pretended, that they 
are not the result of inflammation; it has been forgotten that all 
the causes of adynamic fever excite the vital action of the organs 
which present traces of inflammation after death; that during 
life the phlegmasia is most frequently easily recognised, if we 
observe the patient with attention. 

It has been forgotten that adynamic fever constantly succeeds 



ADYNAMIC FEVER. 199 

synochal gastric or mucous fever, that is to say, an inflammation 
or irritation of some organ, particularly of the digestive organs. 

9. These alterations are not the effect of the fever, if by it be 
understood a group of symptoms; smallness of the pulse, sordes 
of the teeth and prostration, could not determine redness of the 
digestive canal. If by fever be understood an unknown morbid 
state, sui generis, the morbid alterations at least indicate, that 
this state had its seat in the parts where they are detected, and it 
is reasonable to conclude that it was not seated in any other 
part, since it has left no other traces. It only remains, then, to 
determine the nature of this state: now, if when it leaves traces, 
they perfectly resemble those of inflammation, if the causes 
which determine it are the same as those of inflammation, if the 
principal and primary symptoms are inflammatory, and if, in 
inflammations, the nature of which is not contested, we ob- 
serve the supervention of adynamic symptoms, which evidently 
depend upon excessive inflammation; is it not reasonable to con- 
clude, that the morbid state which constitutes adynamic fever, 
is an inflammation? Or, is it desirable that it be considered only 
an irritation? To this I willingly consent, provided it be recog- 
nised, that every irritation consists in an increased vital action, 
and requires the employment of antiphlogistic measures* 

10. Others, still more bold in their assertions, declare that 
these alterations are the result of the general astheny under 
which the patient labours in adynamic fever. If we prove, that 
astheny of the heart, of the stomach, and of the intestines, does 
not determine them, it will be demonstrated at the same time that 
general astheny does not. *^ 

How could the heart alone, in consequence of its weakness, 
give rise to the formation of those gangrenous patches in which 
the tissues, forming the digestive canal, are softened, and often 
reduced to a state of corruption? That the weakness of this 
viscus might favour the transition from inflammation to gangrene, 
there must have existed a previous inflammation; for gangrene 
never exists without previous inflammation, however transient 
this inflammation may have been. Besides, the gangrenous 
patches are but the last effects of the gastro-intestinal phlegmasia, 
which generally gives rise to adynamic symptoms; if we judge 
of them from strangulated hernia, inflammation certainly mani 



200 PHYSIOLOGICAL PYRETOLOGY. 

fests itself before the development of the gangrenous eschars. 
Could the weakness of the heart determine the formation of the 
injected vascular net-work, of the points, of the red patches, in 
certain parts alone of the digestive canal? For local alteration of 
structure we can only imagine a local cause. 

Astheny of the stomach and intestines could not be the cause 
of the phlegmasial alterations presented by the parts after death. 
What effect can this astheny produce? — The stasis of blood in 
the capillary vessels. But this stasis would take place uniform- 
ly, a result not observed in adynamic fever. These alterations 
are, I repeat it, local, and unless we suppose certain parts alone, 
of the intestines to be affected with weakness, we must attribute 
them to an irritation of portions of these organs of greater or 
less extent. Furthermore, it is difficult to imagine how astheny, 
which produces paleness of the tissues during life, should leave 
redness after death; while inflammation, which reddens the tis- 
sues during life, and often after death, throughout the whole sys- 
tem, should not be competent to the production of this effect in 
the mucous membrane of the intestines. 

The redness of the digestive canal has been compared to that 
of the skin, which occurs in the same fever: the latter has been 
ascribed to weakness, and it has been inferred from this, that the 
former has a similar origin; but that this is the cause of the cu- 
ticular redness, has not been proved, and I do not, therefore, 
consider it incumbent upon me to show that it is not the cause 
of the intestinal redness. 

11. It is conceded by some, that the alterations detected after 
death, in whatever organ, are indeed the result of an inflamma- 
tion, to which the adynamic symptoms are willingly referred; 
but these admissions are qualified by the assertion, that this in- 
flammation is essentially asthenic, atonic, adynamic, gangrenous. 
Thus it is, that after admissions, compelled by incontrovertible 
facts, they return to error by adopting an explanation totally de- 
void of sense. 

What can be meant by an asthenic inflammation? Without 
entering upon the consideration of latent inflammation, let us 
mention that which manifests itself by pain, heat, redness, and 
swelling. It is generally admitted, that in every part which 
presents these four phenomena, the blood arrives in greater quan- 



ADYNAMIC FEVER. 201 

tity than in the surrounding parts, that the part affected trans- 
mits to the brain unusual impressions which stimulate it, and occa- 
sion new sensations, violent and painful. Now, how can it be 
imagined, that the blood is determined in unusual quantities to a 
weakened part, solely owing to the fact of its being debilitated? 
And is it not singular, that the reality of this supposed weakness 
should be considered as demonstrated by the phenomena of in- 
flammation, which indicate, on the contrary, that, if this astheny 
existed before them, it ceased when they manifested themselves. 
It may with propriety be maintained, that debilitated parts be- 
come more easily inflamed under the influence of the causes of 
irritation; but whenever they are inflamed, they cease to be 
weak; there is, therefore, no inflammation which essentially con- 
sists in the astheny of any tissue whatsoever. Shall it be said, 
that by an asthenic inflammation, is meant only a sthenic inflam- 
mation like all the phlegmasia, but developed in a debilitated 
individual? This is adopting the true principles of physiological 
pathology; it only remains to recognise the fact, that a subject 
who is debilitated, is not equally so in all his organs; if he be de- 
bilitated in several, he is generally too strong in others, of- 
ten of more importance; that inflammation is always identical, 
whether it manifest itself in strong or weak subjects; that, un- 
der all circumstances, it can vary only in intensity, depth, and 
extent. If the course of inflammation be different in the scor- 
butic and in the young and plethoric, it is owing to the nature 
of the tissues in which it develops itself: in the former, these 
tissues are destroyed slowly or rapidly, but without marked in- 
flammatory phenomena; in the latter, inflammation ceases after 
inflammatory phenomena, always very marked, and which ge- 
nerally develop themselves with rapidity; but in both it always 
constitutes the same morbid process. It would be useless to 
dwell longer upon the demonstration of this truth, proved by 
MM. Canaveri and Tommasini, and placed beyond all doubt by 
M. Broussais. 

"May not," say they, " this inflammation, which you believe 
to be always identical, depend, at least sometimes, upon a delete- 
rious principle, which adheres to the diseased tissues and de 
stroys them, after the manner of caustics, or which modifies 
them so powerfully that even after its removal, their disorganiza- 

26 



202 PHYSIOLOGICAL PYRETOLOGY. 

tion proceeds; provided always we do not oppose to it a thera- 
peutic agent appropriate to the nature of this secret principle, 
rather than of the phlegmasial symptoms, which manifest them- 
selves? This objection derives its whole force from our not 
weighing the value of all its terms. There are, certainly, inflam- 
mations which tend directly to gangrene, since this is a frequent 
termination of the inflammatory state: there are likewise some 
inflammations which nothing can prevent, terminating in this 
manner; the tendency of others to this termination is arrested 
by means which might be supposed to occasion it, — an inflam- 
mation which terminates in gangrene being like all others; but 
an exaltation of the vital action, has nothing in it peculiar: this 
is proved by the fact, that we often succeed in arresting it by 
antiphlogistics, and gangrene does not take place; why should 
the inflammation be specifically different when we arrest it by 
tonics? Antiphlogistic and tonic remedies act not on the cause 
of inflammation, but upon the inflamed tissues: now, what- 
ever be the means by which we dissipate this morbid state, it 
nevertheless is sthenic in its nature. An ophthalmia affects the 
right eye: we treat it by an irritating topical application, and it 
disappears. A few days after it is observed in the left eye; it 
is treated by antiphlogistics, and ceases: must we hence conclude 
that it was sthenic in one eye and asthenic in the other? We 
find a certain number of patients in the same hospital affected 
with gastro-enteritis; some are treated by tonics and others by 
antiphlogistics; in all the symptoms have been the same, with the 
exception of individual shades of intensity and extent: shall it 
be said,, that among those who have been cured by means of, or 
notwithstanding these opposite modes of treatment, some have 
been affected by sthenic and others by asthenic inflammations? 
Unless I have treated very inadequately this subject, so impor- 
tant and so difficult, the reader must be now convinced that such 
a distinction is absurd, and, to remove the possibility of doubt, 
it will be sufficient for me to prove that this celebrated division, 
borrowed from the most objectionable part of the Brunonian 
system, is only founded upon a superficial consideration of the 
sympathetic influence of therapeutic agents, and upon the habit 
of judging of the nature of disease according to properties vague- 
ly assigned by empiricism to medicines. The solution of this 



ADYNAMIC FEVER. 203 

problem is found in this fact, that tonics may sometimes cure an 
inflammation, and this is not more astonishing than to observe 
the strength restored by emollients. Tonics cure inflammation 
either by causing a deprivation to an organ which has hitherto 
remained sound, or by constringing the inflamed tissues. 

12. If truth does not at the first glance strike every mind, it 
need only be presented perseveringly, to induce the most obsti- 
nate to assent to it, so far as to deny only its practical consequences. 
Most physicians of the present day are convinced that there is 
no adynamic fever without the inflammation of an important or- 
gan, and most frequently of a portion, of greater or less extent, of 
the intestinal canal; but the greater number persist in considering 
this inflammation as only a complication of the fever, and not the 
fever itself. Recognising at last the results too long neglected 
of observation, but not knowing how to reconcile them with the 
principles of their medical education, the tone of their opinions 
is derived, not from what they see, but from their cherished ha- 
bits of thinking. Whenever, in practice, they meet with a sub- 
ject affected with gastro-enteritis, with peritonitis, with pneu- 
monia, or any other inflammation, whether confined to a single 
organ or affecting several, and the symptoms of which are 
masked by prostration, instead of pronouncing the disease, as 
formerly, simply adynamic fever, they now denominate it ady- 
namic fever complicated with inflammation of the stomach, the 
intestines, the peritoneum or the lungs. This language would 
be frequently innocent, and only objectionable from its absurdity, 
were it not that the theory which dictates it exercises an influ- 
ence upon practice. But, to show themselves consistent with 
their erroneous opinions, these practitioners attack, on the one 
hand, adynamy with tonics, and, on the other, inflammation 
by antiphlogistics, often employing at the same moment these 
diametrically opposite means. 

It is thus, that the most positive and precious results of ob- 
servation may be neutralized by a theory, founded partly on er- 
ror and partly on truth. The name of disease is of little mo- 
ment, provided there be no mistake with regard to its seat and 
nature, and provided the remedial measures are appropriate to 
both. Let theory and practice harmonize with observation and 
experience, and the danger of an improper name disappears: we 



204 PHYSIOLOGICAL PYRETOLOGY. 

cannot but be astonished, that men, who should be familiar with 
the laws of logical reasoning, should admit in one and the same 
subject, two essential maladies; the one, seconda^ and local, 
owing to excess; the other, primitive and general, owing to de- 
fect of force — maladies, which are to be attacked by tonics ap- 
plied to the inflamed organs, and by debilitating measures act- 
ing primarily upon the weakened organs. 

"In slight fevers," says M. Andral, "the point of departure 
is not always irritation of the digestive passages, (as has been well 
observed by M. Boisseau.) the symptoms may be referred to ir- 
ritation of the encephalon, the bronchia, the intestines, the liver, 
the kidneys, or the muscles themselves. In the more violent 
fevers, also, we observe this multiplicity of lesions."* 

M. Andral establishes three degrees of inflammation in the 
digestive tube; in the first, there is simply injection, more or 
less strong, of the mucous membrane; the second degree is 
marked by alteration of texture, whether it be thickened, soft- 
ened, or exanthematous: this alteration may or may not involve 
the other coats; in the third degree, the mucous membrane, and 
the subjacent tissues becomes disorganized and ulcerated. — 
" These two last degrees," he remarks, u can never be mistaken; 
but to distinguish the first from injection by a stasis of blood, 
we must consider the symptoms that have preceded death, or 
the kind of death, observe the state of the lungs, of the right 
cavities of the heart, of the liver, and of the portal system." 

This author reports, that in the bodies of thirty-eight patients, 
who died of grave fevers, eleven only presented traces of gastri- 
tis sufficiently marked to render it probable that this phlegmasia 
could exercise any influence upon the symptoms during life. 
Thirty, presented redness, exanthems, or ulcerations in the large 
intestines; but in fourteen, only, the lesions appeared to bear a 
proportion to the gravity of the symptoms. In the large intes- 
tines the alterations appeared more unfrequent, and less intense 
than in the other parts of the canal. In five patients, he found 
the digestive tube devoid of all lesions worthy of remark. It 
was only in a very small number of cases that he observed a de- 
cided and very marked phlegmasia of the digestive mucous mem- 
brane, analogous to the inflammation which is observed either 

* Clinique Medicale, 1, 49T. 



ADYNAMIC FEVER. 205 

in the acute form in men and animals, destroyed by corrosive 
poisons, or in the chronic form in persons who die of chronic 
diarrhoea. The mesenteric glands appeared red, tumefied, en- 
gorged in most of the cases where the portions of the intestines 
corresponding to them were ulcerated. In two cases the liver 
was extremely dense; in one it had an unusually red tint; in a 
fourth it was extremely pale. In more than half the cases, the duo- 
denum and superior part of the jejunum and ilium were filled with 
an extraordinary quantity of bile. In the gall-bladder this fluid 
was often black, viscous, of a syrupy consistence: at other times, 
clear, colourless; serous in a scorbutic subject; in a small num- 
ber of cases, the gall duct contained a liquid of a sanious charac- 
ter, and of a dirty gray colour. In many, the spleen presented 
a considerable increase of size, and an extreme softness, a great 
friability. At other times, equally large but less soft, it con- 
tained an enormous quantity of black blood: in a small number 
of cases, it was large and very dense. In two or three cases, 
the pancreas was found injected, and larger than usual, chiefly 
in consequence of the engorgement of its interlobular tissue. 
In one subject, there were traces of a phlegmasia of the mucous 
membrane of the bladder: and in another, a slight injection of 
this membrane. 

The pulmonary parenchyma was sometimes choked with a 
reddish serosity, soft, easily torn, crepitous, sometimes imper- 
meable to the air, easily crushed, and resembling the softened 
spleen. 

M. Andral has ten times observed red hepatization of the 
lungs, viz. thrice in the right lung, once in its superior lobe, 
twice in its inferior; six times in the left lung, once in its superior 
lobe, five times in the inferior, and once in the two lungs, occu* 
pying the left superior and right inferior lobe. Once he found 
gangrene of the centre of the right lung, which was hepatized 
in its inferior part. Gray hepatization was in some subjects 
combined with the red. In three cases, an enormous quantity of 
frothy serosity streamed from the lung, when its substance was 
divided. Twice he found in the lungs membraniform, albumi- 
nous concretions, without effusion. In four, the cavity of the 
lungs contained a sanguinolent serosity. 

In the greater number of subjects, the heart was flaccid and 



206 PHYSIOLOGICAL PYRETOLOGY. 

discoloured, its cavities either empty or containing a small quan- 
tity of black and liquid blood; three or four times it contained 
fibrous clots, without colouring matter, and very soft, which by 
compression, were reduced to a thin and transparent cellular 
net-work, owing to the expulsion of a limpid serosity. The 
blood was limpid, and of a deep black in the great arterial and 
venous trunks. In some subjects, there was observed in the 
heart and great vessels a rosy tint, clear, and resembling water, 
tinged with a small quantity of red colouring matter. Some 
small concrete fibrous grains were disposed here and there upon 
the internal surface of the vessels. In one subject, the liquid 
contained in them was of the colour of lees of wine, in some 
places of a sanious character. In one, a white clot occupied the 
whole extent of the descending thoracic aorta. Once there was 
a bright redness forming isolated patches, more numerous in the 
abdominal than in the thoracic aorta. The great venous trunks 
never presented any thing peculiar. 

Sanguineous effusions existed either in the serous membrane 
of the brain of the spinal marrow, or thorax, or in the sub-se- 
rous, sub-mucous, subcutaneous, or intermuscular cellular tissue. 

In some, almost all these effusions were combined: there was 
no clot, but sometimes a serosity of a more or less deep red, 
sometimes a black liquid, resembling the blood which issues 
from a vein just opened. 

In five subjects, there was a high injection of the meninges, 
which were still transparent; and in four of them, the injection 
was confined to the convexity of the hemispheres; in the fifth, 
it extended to the base of the brain. In another subject, a tur- 
bid lactescent serosity infiltrated the sub-arachnoid cellular tis- 
sue of the convexity of the brain. In a second, the arachnoid 
of the convexity was friable, and tore off in small shreds when 
an attempt was made to raise it, and it carried with it small por- 
tions of the cerebral substance, which was red on its surface. 
In every case, when the arachnoid was injected, the cerebral 
substance was dotted with small red points: these points were 
found, in some subjects, conjoined with sanguine engorgement 
of the cerebral veins, without injection of the meninges. Twice 
the encephalic mass presented a remarkable hardness. M. An- 
dral does not notice the effusion, except when in sufficient quan- 



ADYNAMIC FEVER. 207 

tity to elevate the arachnoid memhrane in a sensible degree, to 
separate the convolutions, distend the ventricles, or occupy a 
great part of the inferior occipital fossae: this he did not detect in 
one of the thirty-eight bodies. The spinal marrow, examined 
in a considerable number of cases, never presented any sensible 
alteration. In two other subjects, who succumbed under a group 
of ataxo-adynamic symptoms, of a marked character, the semi- 
lunar ganglion was found of remarkable redness, which seemed 
to be produced by a very high injection of the cellular tissue, 
interposed between the small grains which compose this gan- 
glion. One of these subjects presented, during the last twen- 
ty-four hours of his existence, a violent trismus, and a rigidity 
of the thoracic extremities. 

Finally, M. Andral has often found the muscles black and li- 
vid; sometimes the muscles of different parts of the body ap- 
peared to him to have undergone, in less than five days, a real 
atrophy in their fibres.* 

Laennec admits that in the essential fevers a slight degree of 
peripneumony, a sanguine afflux to the lungs, or at least, a ca- 
tarrh, which engorges with mucosities the bronchial ramifications, 
a redness and thickening of their internal membrane, are local 
affections of at least equal frequency with the thickening and ul- 
ceration of the mucous membrane of the intestines.! The soft- 
ening and the violet colour of the heart are observed, especially 
in the grave essential fevers, says this author, and particularly 
in those which present the group of symptoms described by Pi- 
nel under the name of adynamic fever; % this is peculiarly the 
case where they present in a very marked manner the symp- 
toms which were regarded by the ancients as indicating putre- 
scency; viz. a livid tumefaction of the face, a softening of the 
lips, the gums, and generally of the internal membrane of the 
mouth, a sordid coating of the tongue and gums, an earthy as- 
pect of the skin, meteorism of the belly, and very fetid dejec- 
tions. "I would not dare," says he, " to assert that softening 
of the heart occurs in all essential fevers — yet I have never failed 
to observe it when I have directed my attention to the fact. 
Can it be the cause of the frequency of the pulse which is so 

* Clinique Medicale, 1, 402. f Ausc. Med. 1, 2. 

X Ibid, p. 287. 



208 PHYSIOLOGICAL PYRETOLOGY. 

often observed, and which sometimes continues many weeks, 
although the patient recovers his strength and embonpoint.''* 

" For a long time I have seen with astonishment, says M. 
Ribes, " that the symptoms of adynamic fever and all the func- 
tional disturbance observed during its course, have been attri- 
buted to certain inflamed points of the intestinal canal — I cannot 
believe that a cause so slight can give rise to such disorders, es- 
pecially when I reflect that in strangulated hernia, with inflam- 
mation of a great extent of the intestines, and sometimes of the 
stomach, the patient often recovers, even when the inflammation 
of the strangulated part terminates in gangrene. After having 
for a long time endeavoured in vain to account for the difference 
in these two states, I examined the solar plexus and the nervous 
fasciculi derived from it. I think I observed in some cases that 
the nervous filaments which compose these fasciculi, were a lit- 
tle red, but more frequently, although there is no doubt that 
these nerves are affected in this disease, I was unable to recog- 
nise any change in their colour; it then appeared to me that 
other organs should be found affected — I turned my attention to 
the arteries which are distributed to the alimentary canal. Com- 
mencing with the coeliac trunk, I passed thence in succession to 
the superior and inferior mesenteric arteries — I examined them 
throughout the whole extent of the ramifications which could be 
opened, and I never found an alteration of sufficient conse- 
quence to account for the symptoms of this disease But the 
case was different when I directed my attention to the veins. 
In almost all the subjects who had died of adynamic fever, I 
found traces of inflammation in the trunk and branches of the 
ventral portion of the vena portarum, and sometimes also in the 
hepatic portion of this vein, extending even to the right ventricle 
and auricle of the heart. I had so often found the veins in- 
flamed in the case under consideration, that in 1S16 I thought 
myself authorized to announce that the veins and the venous 
blood were principally affected in adynamic fever. We meet, 
it is true, with subjects in whom the inflammation of the veins 
is but slightly marked; but we know with what rapidity such 
marks are effaced by death. If we examine the part affected 

* Ausc. Med. 1, 2. 



ADYNAMIC FEVER. 209 

with erysipelas in subjects who have died of this disease, al- 
most all traces of inflammation have disappeared: the same thing 
occurs in inflammation of the veins; but yet, however slight it 
may have been, the practitioner at all accustomed to the exami- 
nation of bodies, and to observe this kind of cases, will not be 
deceived, but will readily discover whether there has been in- 
flammation in the vein. Thus, it is proved to my satisfaction 
that in individuals who have died of adynamic fever, however 
slight in appearance may have been the inflammation of the 
intestines, there is always inflammation in the ventral vena por- 
tarum. After these remarks, it will be seen that in enteritis 
and gastro-enteritis, if the irritation and inflammation of these 
parts extend to the liver, it is not only through the ductus 
choledochus; the ventral and hepatic vena portarum appears to 
be the principal means of transmission. 

We perceive that M. Andral has discovered after fevers, the 
alterations I have pointed out, that he entertains the opinions 
which I am desirous of circulating, because I believe them based 
upon truth. The difference of sentiment which seems to exist 
between us, on many points, is rather apparent than real. Laen- 
nec contributes to prove, without desiring it, that there is no 
essential fever without organic alteration. M. Ribes adds to 
the mass of proofs, the results of his interesting researches in 
pathological anatomy. Numerous remarks might be made on 
the reflections made by these authors upon the facts which they 
report, but after the detailed method in which the subject has 
been treated, it would be paying but a poor compliment to the 
intelligence of the reader, to enter upon such a controversy. If 
what is asserted byLaennec, and MM. Ribes and Bouillaud, be 
verified, if the contradiction which appears in some of these as- 
sertions should disappear, the science would be enriched with 
new facts; but it would not on this account undergo any funda- 
mental modification: should it be established, that one or two 
organs in addition, are inflamed in adynamic fever, it would 
produce no change in what is already demonstrated, with regard 
to the nature of the lesion which constitutes it; it would only- 
show that the seat of the disease was more extended, and its dan- 
gerous character surprising. * 
* See, on the pathological anatomy of the digestive apparatus; Chaussier, 

27 



210 PHYSIOLOGICAL PYRETOLOGY. 

In the second edition of his Clinique. M. Andral concludes 
from his anatomical researches that, in the continued pyrexias 
which constitute the various morbid groups, designated in the 
nosography of Pinel, by the name of essential fever, lesions of 
the digestive canal are not constantly found after death. He 
adds, that in these diseases, we find in 95 cases out of 100, le- 
sions in the digestive tube. This fact impressed him so strong- 
ly, that he at last ranked fevers among the diseases of the abdo- 
minal organs. The alterations were not found of equal frequency 
in the different parts of the digestive tube. He found the 
stomach sound in a considerable number of patients, however 
great had been the violence of the disease. The alterations 
found in the viscera seemed to him to possess nothing special, 
nothing which could constitute their anatomical character, be- 
cause they did not differ from those discovered in individuals 

Bulletin des Sciences Medicaids du Department de TEv.re. n. 53: Gerard, 
Des Perforations Spontanees de TEsto.nac, Paris, an. xii; J. Cloquet star les 
Perforations Intestinales dans le Nouveau Journal de Medicine, i. 107; E. 
Legalibis Plusieurs Perforations du Canal Intestinal et Specialment des 
gros Intestines, a la Suite Tune Affection Tuberculeu.se. Arch. Gen. de Me- 
dicine, vi. 68; Louis, Du Ramollissement avec Ammcissemeni et de la De- 
struction de la Membrane Muquev.se de TEstomac, et Observations relative 
aux Perforations Spontanees de Vlntestin grele, meme recueil, i. 17. v. 5: 
U. Coste. Observations sur les Perforations ■'-: '' Ei'.ernac dans le Journal 
Vniversel des Sciences Medicales. xxix. 257; D. Coutetten, Recherches de- 
monstrant le rapport qui existe entre flrritation de la Membrane Muquev.se 
du Ca7ial Digestive, et ceTle de la meningine, meme recueil, xxviii. 257: L. 
Seam, SurV Anatomie Pathologique du Canal Digestive, meme recuiel : Rous- 
seau. Mernoire sur la Membrane Muqv.ev.se Gastro-Intestinc^. dans Archiv. 
de Med., vi. 454; A.Boulland, Recherches sur les Characteres Anatomiqu.es de 
V Inflammation. 1S24. in4to; C. Biilard, de la Membrane Muquev.se Gastro- 
Intestinale, dans Tetat sain et dans Tetat Inflammatoire, 1825, in Bvu : F. Ya- 
quie, Mernoire sur les traces <T Inflammation dans les Msceres Abdominaux 
apres les Fievres Putride et Ataxique. dansle Journ. Compl. dv. Diet, des Sc, 
Med. xxii. 3 r 290; J. Crureilheir, Anatomie Pathologique du corps hinnain, 
avec des figures coloriees, 1830, infoL (livrais. 4, 7. et 10:" Andral, Clinique 
Precis a" Anatomie Pathologique; Carswell, Recherches sur la Dissolution 
Chemique ou Digestion des parois de VEstomae. apres le. Mc-rt; cans le 
Journ. Hebdom. de Med. 1530, vti. pag. 321 et 505. This article, the au- 
thor of which makes great pretensions, is only a fond recapitulation of cer- 
tain experiments upon animals subjected to conditions which are net those 
which conduce to the production of fever. 



ADYNAMIC FEVER. 211 

who had died of any other disease, whether acute or chronic; 
because they are found with nearly equal frequency in those who 
die during a continued fever, and those who are cut off by other 
diseases. Whence he concludes, that every fever called essen- 
tial, is not necessarily the product of a gastritis, and that the 
traces of gastritis detected upon opening bodies, cannot satis- 
factorily account for the diverse morbid groups, called essential 
fevers. Before considering an inflammatory state of the sto- 
mach as constituting these maladies, he thinks it proper to de- 
duct from what may be considered as marks of an inflammatory 
state, the diverse alterations which may be due to some other 
cause than irritation, and of which many occur after death. We 
shall then find, according to this author, that the number of cases 
in which we refer the fever to a gastric phlogosis, becomes less 
considerable than we should suppose. 

M. Andral, in the endeavour to confine himself within the li- 
mits of facts, has evidently gone too far in ranking fevers among 
the diseases of the abdominal organs. I do not think, that if 
we include among essential fevers, those which were formerly 
called ataxic, we shall in ninety-eight cases out of a hundred, 
discover lesions in the digestive tube. But he is right when he 
asserts that the stomach does not always present morbid traces 
after fever; we should, however, be cautious not to consider as 
post mortem changes the inflammatory redness which is frequent- 
ly misunderstood from the fear of seeing traces of gastritis where 
it has not existed. 

There is not, say they, any thing special in the traces which 
the digestive organs present after death, nothing which can 
assign a peculiar anatomical character to these fevers. M. An- 
dral is right, and this is one of the strongest proofs lhat fe- 
vers are not special essential diseases. We cannot be surprised 
that the same organic lesion exists in one subject with, in another 
without, reaction or languor of the circulatory system. There 
is scarcely any alteration of tissue which constantly corresponds 
to a particular symptom or alteration of function. 

Moreover, if the morbid traces of the organs are not peculiar 
to the groups of symptoms called essential fevers, we cannot 
be astonished if they do not correspond specially to any among 
them. 



212 PHYSIOLOGICAL PYRETOLOGY. 

Finally, we must, doubtless, avoid regarding as a result of the 
inflammatory state, whatever is derived from another source — 
but this is a consummation which the future alone can realize, if 
it be true, that inflammation may exist without connexion with 
another morbid state affecting the part which it occupies. 

" With regard to the small intestine," says M. Andral, "mor- 
bid changes in it are observed more frequently in proportion as 
we examine it nearer its union with the great intestine. But, he 
assures us he has very rarely found the duodenum affected: this 
appears to me to be the result of his attaching too little import- 
ance to lesions, the value of which, M. Broussais has demon- 
strated. M. Andral has seldom found the small intestine sound. 
Sometimes he has observed the follicles of Brunner more appa- 
rent than usual, and marked with grayish points at their orifices, 
which, according to him, were the product of a morbid state an- 
terior to death, and which, at the period of death, was on the 
decline. At other times, in place of the morbid patches, the 
mucous membrane was found thinner than in the intermediate 
points: this membrane he considered a new formation, occupy- 
ing the place of the cicatrized ulcers. These two opinions do 
not as yet appear to me well established. Both seem wanting 
in direct proofs, which the opening of diseased animals alone 
can furnish. The second is opposed by the excessive and uni- 
form thinness of almost the whole extent of the small intestine, 
after a great number of adynamic fevers. A fact, which I have 
frequently verified in the hospitals of Val de Grace, and Gros- 
Caillou. 

It has been remarked, that the vascular injection of the small 
intestine does not take place always in the mucous membrane, 
properly so called; it is sometimes confined to the villosities of 
this membrane. The justice of this observation, made by M. 
Scoutetten, and which has induced him to distinguish enteritis 
into membranous and follicular, has been established by M. An- 
dral. 

MM. Petit and Serres, pointed out this morbid development 
of the follicles of the intestines, in 1813, and M. Andral, in de- 
scribing this alteration in the first edition of his Clinique, men- 
tioned his predecessors and gave to this appearance the name of 
intestinal exanthem. MM. Bretonneau and Louis, have since 



ADYNAMIC FEVER. 213 

made it the subject of special research. The physician of Tours 
assigns the name of dothinenterie, or furoncular disease of the 
intestine, to this affection of the follicles, which he considers as 
a peculiar malady, sui generis. M. Louis, desirous of a word 
expressive of the anatomical character, without being disagree- 
able to the ear, gives it the name of the typhoid affection.* 

He regards it as an acute disease, accompanied with a febrile 
movement, more or less intense, variable in its duration; pecu- 
liar to young subjects, particularly to those who have been for a 
short time exposed to the influence of new circumstances ; it makes 
its appearance with a violent rigor, anorexia, thirst, and in a great 
majority of cases, with colic and diarrhoea; it is in a short time ac- 
companied with a debility, out of proportion to the other symp- 
toms, and, after a variable period, with somnolence, stupor, de- 
lirium, meteorism, sudamina, lenticular, rosy spots, eschars on 
the sacrum, ulcerations of the skin, of various depths, succeed- 
ing the application of blisters, deafness, spasmodic movements, 
a permanent contraction of the limbs; symptoms, of which some 
are transient and others increase generally in a progressive man- 
ner, till the fatal termination; or to diminish more or less rapid- 
ly, to disappear entirely at last, if the affection have a happy 
issue. The anatomical character of the affection consists in a 
special alteration of the elliptical folds of the ilium, or of the 
Glandulae Peyeri. 

In fifty subjects, who died after having presented these symp- 
toms, M. Louis always observed the folds more or less deeply 
altered, in an extent varying from one to eight feet, softened, 
thickened, red or bluish, ulcerated or not ulcerated, and in many 
of them there was no other lesion of the intestinal canal. He has 
never observed these alterations in subjects who presented other 
symptoms, except in a single instance, when death occurred af- 
ter prostration, and three of the intestinal folds were found red, 
and somewhat thickened. 

He asserts that these symptoms and these alterations united, 
constitute a disease, sui generis; to which have been assigned 

* Recherches Anatomiques, Pathologiques et Therapeutics sur les Mala- 
die, connue sous les noms de GastroEnterite, Fievre Putride, Adynamique, 
Ataxique, Typhoide, &c, consideree dans ses rapports avec les autres Affec- 
tions Aigues. Paris, 1829, tome 2, in 8vo. 



214 PHYSIOLOGICAL PYRETOLOGY. 

the names of putrid, adynamic, ataxic, and typhoid fever, and of 
gastro-enteritis, and which differs from enteritis, properly so 
called, more than pulmonary catarrh differs from peripneumonia, 
and rubeola from variola. 

Let us remark, in the first place, that M. Louis reports a fact 
which forms an exception to the rule which he lays down. Let 
us then examine upon what grounds he decides that vascular bo- 
dies, tumefied, red, and ulcerated after death, have not been in- 
flamed during life. Whilst a third part of the patients affected 
with typhus fever perish, enteritis in its acute form, according to 
M. Louis, attacking healthy subjects, is so rarely fatal, that it 
would be difficult to point out its seat with much precision, were 
it not very often found in those who die of other acute af- 
fections. 

3IM. Andral and Bouillaud deny that this special alteration of 
the elliptical folds has not been observed except after the symp- 
toms which M. Louis gives as signs of the alteration. I could 
add my testimony to theirs upon this subject, but M. Louis 
would, perhaps, be ready to say that his researches having been 
of more recent date than mine, I may have overlooked what ap- 
pears to have entirely absorbed his attention. Yet I shall not 
hesitate to call the attention of practitioners to this point, which 
has now become important: for the question is, whether M. Louis 
is authorized in making of all fevers accompanied with prostra- 
tion and somnolence, so many diseases, not of the intestines ge- 
nerally, but of the small intestine; and still farther, so many 
cases of tumefaction with redness, and of ulceration without in- 
flammation- 

What shall we say of the other differences, which he thinks 
he perceives between acute enteritis and the typhoid affection. 
According to him the latter commences with a febrile movement, 
generally intense, and soon accompanied with loss of strength, 
in a greater degree than corresponds with the other symptoms, 
with somnolence, stupor, delirium and eruptions; the conva- 
lescence is always tedious. The former, on the contrary, is ge- 
nerally accompanied by only a slight febrile movement — a loss 
of strength, which is inconsiderable, or only proportioned to the 
abundance of the alvine evacuations; somnolence is extremely 
rare, and bears a relation to debility, and is never comparable to 



ADYNAMIC FEVER. 215 

that which occurs in the typhoid affection; there is commonly 
no eruption, &c. : when the patient does not perish, convalescence 
is rapid. 

To what docs this parallel amount, except to this; that the 
more serious the enteritis is, the more marked are its symptoms, 
and the more considerable the number of sympathetic phe- 
nomena? 

Are we hence to conclude that the researches of M. Louis 
are devoid of utility? No, this is never the case with researches so 
laborious. They have an importance which he has not suspected, 
an importance much superior to that which he ascribes to them. 
He has the honour of having established the very frequent coin- 
cidence of certain alterations, which inflammation determines in 
the small intestine, with the symptoms given before the re- 
searches of MM. Prost and Broussais, as the signs of putrid, 
adynamic and ataxic fever, that is, of the diseases which were con- 
sidered general; M. Louis has, therefore, done much towards 
the localization of febrile disease; and, if there be some danger of 
being led by him into error, with regard to the nature of these 
diseases, he has at least thrown light upon the subject of their 
seat. We should be authorized in concluding, from his dissec- 
tions, that adynamic fever is more frequently an enteritis than 
a gastro-enteritis, had he not too lightly estimated the gastro- 
intestinal redness. 

In giving to the disease called by M. Louis the typhoid affec- 
tion, the name of iliodicliditis, M. Bally has come nearer 
to the truth; but the denomination of follicular enteritis, em- 
ployed by MM. Billard* and Cruveilheirt appears preferable to 
any other. 

* Traite des Enfants Nouveau-nes et a la Mamclle fonde sur de Nou- 
velles Observations Cliniques et d? Anatomic Pathologique. Paris, 1828 ; ire 
8vo. 

f Anatome Pathologique des Cords Humain, ou, Description et Figures 
coloriees des diverses alterations Morbides. Paris, 1830; grand in fol. (7e 
livraison.) In four plates of remarkable accuracy, M. Cruveilheir has re- 
presented the varieties of alteration occurring in the small intestine. I would 
call the attention of my readers, and particularly of physicians who possess 
but limited opportunity for post mortem examination, to this work, remarka- 
ble for the exactness of the descriptions and of the drawings. 



216 PHYSIOLOGICAL PYRETOLOGY. 



Treatment of Adynamic Fever, 

Hitherto I have said nothing on the prognosis of adynamic 
fever, because it depends so intimately on the influence of treat- 
ment, that it cannot be properly discussed before it. Adynamic 
fever has been classed among diseases of the most fatal character, 
on account of the great number of patients who die when a 
tonic treatment is employed; yet this has not prevented these 
means being considered as the only appropriate remedy. An 
important remark, and one which throws some light upon the 
question I am about to examine, is, that as long as the tonic 
treatment was generally employed, its inemcacy in most cases 
was complained of; whilst, as soon as a different treatment was 
proposed, the efficacy of tonics was declared, in the loudest 
terms. Whence this contradiction? Its source may without 
difficulty be discovered in the human heart; but it is sufficient 
to remark, that unprejudiced physicians, strangers to all sectarian 
feeling, admit the inutility of tonics in most adynamic fevers. It 
is for this same reason, that the most respectable authors have 
insisted on the necessity of these means, the instant the slightest 
symptom of adynamy appeared. This advice is judicious: too 
much could not be done to prevent a disease which is so rarely 
cured. The language of Pinel is: {i These fevers often termi- 
nate fatally."* I do not fear to affirm, after ten years of observa- 
tion, in France, Spain, Germany, and Hungary, that the average 
of subjects who die of adynamic fever, sporadic or epidemic, 
when tonics are employed, is to the number of subjects attacked 
as three to four: let it be clearly understood; that we are not 
here treating of that chimerical disease, called essential ady- 
namic fever, but of gastric or mucous fevers, of manifest inflam- 
mations, with symptoms of apparent debility, to which has been 
given the name of adynamic or typhoid fever, simple or com- 
plicated, in a great measure according to the caprice of the 
observer. 

We have no exact data with regard to the mortality of ady- 
namic fever, abandoned to nature, because, in the absence of 
medical aid, the patients are too often gorged with wine and 

* Nos. Phil., tome 1, p. 175. 



ADYNAMIC FEVER, 217 

other stimulating drinks. However, from an attentive observa- 
tion of our army hospitals, we may be assured that the use of 
cinchona has not diminished the number of fatal cases. What 
physician or surgeon has not seen men attacked with this for- 
midable adynamic fever, when placed in wagons to avoid the ene- 
my become convalescent during the journey, without having had 
recourse to medicines. I could easily mention the names of many 
surgeons, who have in this manner recovered their health, were 
not these facts too generally known to render it. necessary to 
prove them. I myself escaped the danger of a gastro-enteritis 
with adynamic symptoms, without having taken unless during, 
convalescence, the tonic potions which were prescribed for me 
by a practitioner of reputation. 

Among the patients treated by tonics who recover from ady- 
namic fever, there are certainly some, who are cured, notwith- 
standing these means, and not by them. The symptoms very 
seldom become promptly meliorated; the signs of weakness Ge- 
nerally augment in intensity: in the most happy cases, the dis- 
ease grows worse for many days, or even during one or two 
weeks, until, at last, the symptoms diminish gradually, and the 
patient recovers from his prostration. Is it not reasonable to 
suppose, that if tonics were appropriate to the nature of the dis- 
ease, we should more frequently observe a rapid improvement 
under their employment, as is generally the case under the anti- 
phlogistic treatment? 

The tonic treatment and the emetic, which have been reoom- 
mended against the adynamic fever, are decidedly contra-indi- 
cated, 1st, by the nature of the causes of this disease, which ge- 
nerally act by stimulating the internal organs, and particularly 
the digestive organs: 2dly, by the supposed nature of the causes 
which, if they indeed debilitate, would preclude the use of eva- 
cuants; 3dly, by the symptoms, which announce in almost every 
case the inflammation of an important viscus, and generally of 
the digestive passages themselves, thus contra-indicating at once 
both emetics and tonics; 4thly, by the well known nature of sy- 
nochal, bilious, gastric or mucous fevers, the symptoms of which 
almost always precede or accompany those of adynamic fever; 
5thly, by the traces of phlegmasia, which are found in most sub- 
jects after this fever, generally in the digestive organs, and 

2S 



218 PHYSIOLOGICAL PYRETOLOGY. 

sometimes also in other organs: 6thly, finally, by the unhappy 
consequences resulting from the employment of tonics and eme- 
tics in the greater number of cases. 

How has it happened that for so long a period opinions derived 
solely from theory, should have confined the practice to means 
possessed of so little efficacy? I assert that the tonic treatment 
was adopted solely on account of theoretic views, and it is easy 
to demonstrate the assertion. In the first place, it is very evi- 
dent that their employment is persevered in, not on account of 
any advantage derived from them: in the second place, to show 
that I assume nothing which cannot be proved, it will be suffi- 
cient to cite the following passage. a In the fevers called putrid, 
where the vital power is diminished and the actions dependent 
upon it much weakened, the heart is incapable of disembarrass- 
ing itself of the blood which accumulates in it, and the quantity of 
which, irritates it so much as to permit only small and frequent 
contractions, as in the cold stage of intermittent fever. In this 
case the same spasm and paleness continue without intermission; 
the extraordinary stupor and the weight of the muscular parts 
which the diminution of the vital principle, occasions, op- 
pose an obstacle to the propulsive force of the heart and to the 
propagation of the movement of the blood. To restore their 
accustomed vigour to the contractions of the heart, we are com- 
pelled to obviate its debility by the employment of tonic stimu- 
lants, which may solicit it to fulfil its functions or excite the vi- 
tal energy which is prostrated. "* I entirely misapprehend this 
passage, or Pinel has advised the tonic treatment from views 
entirely theoretic, and, what is more remarkable, after a theory 
drawn from the writings of Boerhaave and his verbose commen- 
tator. Since it is not experience which has caused the adoption 
of the tonic practice in adynamic fever, but merely reasonings 
founded solely upon an erroneous idea of the nature of this fever, 
since tonics have been given only because this fever was attri- 
buted to weakness as the humoralists had given them because 
they attributed the disease to putrescency; finally, since experi- 
ence demonstrates that this treatment is possessed of so little ef- 
ficacy, what plausible motive does there remain to continue it? 



* Noa Phil., tome, 1, p. 12L 



ADYNAMIC FEVER. 219 

Were there no other motives, these would be sufficient for its 
abandonment. 

But, farther, the employment of tonic remedies in the disease 
of which we are treating is not only based upon an erroneous 
theory, it is not only useless in a great number of cases; it is dan- 
gerous, even fatal, in the greater number. 

Let the practitioner at this moment call to mind all the cases 
of adynamic fever, which he has observed, and let him say whe- 
ther he has not, in almost every instance, seen the adynamic 
symptoms become aggravated immediately after the administra- 
tion of tonics, even when the disease has not terminated fatally; 
let him say whether in most cases, where he has proceeded to 
the exhibition of tonics, immediately upon the slightest appear- 
ance of adynamic symptoms, he has not seen the whole series of 
symptoms of this nature rapidly and almost suddenly super- 
vene. Finally, let him compare the number of cures with the 
number of deaths in his practice, and let him say with frankness 
whether the author of the History of Chronic Phlegmasia was 
deserving of contempt when he announced* a mode of treatment, 
more efficacious than the method generally employed until that 
period. 

For a long time, it is true, the danger of tonics, in many cases, 
and their inutility in others had been recognised : many celebrated 
physicians, among whom may be mentioned Potalli, Gui Patin, 
Hecquet, Chirac, Baglivi, Van Swieten, Dehaen, Sydenham, 
Huxham, and Stoll, had limited the number of cases in which 
these means are indicated. They recognised the superior utility, 
in some cases, of antiphlogistics, or at least considered it proper 
to commence the treatment with them. But though we must 
admit the sagacity of these physicians, in presuming, simply by 
the inspection of the symptoms, what post mortem observation 
has since demonstrated, and what clinical observation of the an- 
tiphlogistic treatment has placed beyond all doubt, we must yet 
confess that their remarks were entirely lost upon their cotem- 
poraries and upon posterity, because they themselves had not 
proceeded sufficiently far. Brown afterwards entirely deserted 
the path of experience; and his doctrine, since reproduced under 

* Premier Examcn des Doctrines Medicales. Pari.s 1^16; in 8ya 



220 PHYSIOLOGICAL PYRETOLOGY. 

different terms, has conduced to the administration of tonics in 
all fevers with prostration of muscular force. A first and uncer- 
tain step was taken in Italy, by MM. Rasori and Tommasini,* 
towards a melioration which had become very necessary; but it 
is in France, and by M. Broussais, that the problem of the na- 
ture of adynamic fever has been decidedly solved; and the treat- 
ment of this fever has since then reposed upon a solid founda- 
tion, although many researches remain to be made with regard 
to the modifications it should undergo in certain cases. 

It is in this spirit that I proceed to an exposition of the prin- 
ciples, which should direct us in the choice of means proper for 
the prevention or cure of adynamic fever. These principles dif- 
fer little from those professed by M. Broussais: their difference, 
however, is such as to render it proper to call the /attention of 
practitioners to the subject, that they may decide whether I have 
approached nearer to the truth, or receded from it. 

The inefficacy of tonics in adynamic fever had induced physi- 
cians to seek the means of preventing the development of the 
disease, rather than those of curing it. But, instead of endea- 
vouring to perfect the treatment of the diseases of which adyna- 
mic fever is always, to use their own language, either the com- 
plication or the termination, they have only recommended certain 
precautions, of public or private hygeine, with the hope of ren- 
dering this fever less common. Here, again, theory exerts a 
prejudicial influence over experience* by giving it a false direc- 
tion. Sinee adynamic fever is never primitive, (a fact which 
must be true, since there is no longer any difference of opinion 
upon the subject,) the first care, with a view of preventing the 
development of the fever, should be to prevent the diseases which 
bring it in their train, or to arrest their progress. 

Wholesome food, sobriety, moderate exercise, firmness in 
misfortune and public calamity, cleanliness of clothing and of 
apartments, are, in a general manner, the conditions most proper 
for preventing the development of the fevers, which, after a very 
short continuance, or even suddenly, present adynamic symp- 
toms in union with those which characterize them. But the in- 
digent, the soldier, the inhabitants of a besieged town, of a ves- 

* Dell' Infiammazione e della Febre continua. Pisa, 1826-7. 2 vols, in 8vo. 



ADYNAMIC FEVER. 221 

sel, a prison, or a hospital, cannot place themselves in favourable 
circumstances, nor, in most cases, withdraw themselves from 
unfavourable ones. 

It is the duty, therefore, of governments to ensure a perma- 
nent supply of provisions, and provide for the salubrity of towns 
and public habitations,' by cleanliness and the means of disinfec- 
tion: instructions should be published indicating the necessary 
precautions, and facilitating their employment. 

The attention of the authorities should be directed to the fol- 
lowing particulars; viz. 

1. The distribution of clothing, food, and fuel among the poor; 
a rigid examination of the substances destined for the magazines 
and markets. 2. The opening of large temporary hospitals, out 
of the city, if circumstances permit it, when the permanent hos- 
pitals are insufficient, or when they are crowded; with a view to 
have as few of the sick as possible in the houses of the town.* 
3. Care should be taken not to crowd the sick together, and to 
keep them separated as far as possible from each other. 4. The 
ventilation of the wards of the hospitals, and the disengagement 
of chlorine in their establishments, as also in vessels, arsenals, 
barracks, and in private houses, in which the sick reside. 5. 
Proclamations should be made, with a view to allay public alarm 
with regard to the danger, which is always exaggerated by fear 
and malevolence. , 

Such are the principal subjects to which the attention of go- 
vernment should be directed, under circumstances capable of 
favouring the development of diseases" ranked among epidemic 
adynamic fevers. 

With a view to the prevention of adynamic fever, it has been 
recommended, ISt, not to bleed, or to bleed but little in inflam- 
matory fever; 2dly, to provoke vomiting in gastric or mucous 
fever; 3dly, to resort to tonics whenever the first appearance of 
prostration is perceived. 

Experience demonstrates, that inflammatory fever never be- 
comes adynamic in consequence of venesection, unless when it 
is the consequence of gastro-enteritis, which rarely diminishes 

* Adynamic epidemics developing 1 themselves in ships are the more fatal 
and difficult to remedy, from the impossibility of entirely isolating those in 
.health, and separating the patients from one another. 



222 PHYSIOLOGICAL PYRETOLOGY. 

under the influence of venesection. But, in this case, prostration 
supervenes, not because it has been abstracted, but because it has 
been taken suddenly from a vein; because the circulatory appa- 
ratus has been suddenly emptied, instead of the blood being 
gradually abstracted from the part nearest the seat of inflamma- 
tion. Whenever the inflammatory fever is not in consequence 
of gastro-enteritis, or at least when the inflammation does not 
predominate, venesection is preferable, and there is no physi- 
cian who has not seen the symptoms of a pretended adynamic 
fever disappear as the blood flowed. The abstraction of blood, 
then, regulated by the seat of the phlegmasia which gives rise 
to the symptoms of inflammatory fever, and proportioned to the 
degree of this phlegmasia, constitutes, with the rest of the anti- 
phlogistic treatment, the best means to prevent the appearance 
of the adynamic symptoms. 

2. I have already insisted upon the danger of an injudicious 
exhibition of emetics in gastric and mucous fevers; it has been 
demonstrated that the nature and seat of the phlegmasia, consti- 
tuting these diseases, contra-indicates the employment of these 
means, and require, on the contrary, the methodical employ- 
ment of topical blood-letting in almost every case. What I 
have named humid or putrid adynamic fever , being always 
the highest degree of gastric, bilious, or mucous fever, an emetic, 
far from preventing the development of adynamic fever, is, on 
the contrary, the most certain means of favouring its develop- 
ment. This is also frequently the case in sporadic gastric, or 
mucous fever, and almost always in those fevers when they are 
epidemic. What practitioner has not seen adynamic symptoms 
immediately follow the administration of an emetic in most of 
these diseases? — It is useless to cite cases in which this means 
has prevented the development of adynamy; this happy result is 
very unfrequent, since adynamy is frequent after these fevers, 
and when it is supposed that it has been prevented, what proof 
is there that it would have occurred? Shall it be said that the 
nature of the epidemic proves it? One of the most dangerous 
errors in medicine, certainly, is the desire to treat all patients in 
the same manner, in a certain district, in a certain country, ow- 
ing solely to the fact that among a multitude of prevailing dis- 
eases, one or more extensively spread than the rest. 



ADYNAMIC FEVER. 223 

I have a thousand times witnessed the administration of eme- 
tics in epidemic adynamic fever. I have myself administered 
them very often, and when they have not been hurtful. I have 
not seen them dissipate even the simple prostration which ac- 
companies all acute diseases. I have never witnessed the disap- 
pearance, after an emetic, of the intense symptoms which I 
have reported on the authority of Pinel at the commencement 
of this chapter. On the contrary, these symptoms have almost 
always increased, and the patients have always perished when 
these means have been persisted in. Let those who have wit- 
nessed a different result declare the fact, and it will then only 
remain to establish the comparative frequency of these two or- 
ders of facts: as to myself I can only relate what I have wit- 
nessed, and unhappily I have had too many opportunities of ob- 
serving epidemic adynamic fever. 

If the number of cases in which an emetic is proper be limit- 
ed to those in which there is not gastric or mucous fever, but a 
surcharge of the primal viae, we must in the first place recognise 
that an emetic is not indicated by the adynamic symptoms. In 
the second place, if experience proves that the symptoms of this 
pretended surcharge are ordinarily only those of gastritis, duo- 
denitis, or hepatitis, of little intensity, but capable of being ex- 
asperated, under the influence of an emetic; finally, if the ex- 
acerbation of the gastro-enteritis be more to be feared under the 
circumstances which favour the manifestation of the adynamic 
symptoms, is it not reasonable to conclude, that if there are 
cases in which an emetic may be prescribed with impunity, with 
a view to dissipate bilious or mucous symptoms, this means 
should always be rejected when there is cause to apprehend ady- 
namy? 

A decisive fact is the rare occurrence of adynamic fever in 
the establishments in which fever is treated by the local abstrac- 
tion of blood and other antiphlogistic means. To believe this 
fact I am aware we must witness it. Now, since physicians 
cannot leave their patients to follow the practice of their bre 
thren, let them, at least for the moment, adopt the antiphlogis- 
tic method; let them direct it according to the principles of a 
sound physiology, which derives daily confirmation from the 
experience of physicians whose good faith and intelligence there 



224 PHYSIOLOGICAL PYRETOLOGY. 

is no reason to doubt; let them employ this method with firm- 
ness and not in a timid and vacillating manner, and they will 
soon acquiesce in our opinion on the subject. I consider it in- 
cumbent upon me to declare in this place how much profit I 
have derived from witnessing the practice of M. Broussais. It 
was not in his course of lectures, that I studied his principles of 
treatment. I have only followed the lessons which he gave at 
the bed-side of the patient, and it was there particularly that I 
became convinced that the antiphlogistic treatment is the best 
calculated to prevent adynamic symptoms. 

It is only at the bed-side of the patient that we can form 
an unprejudiced judgment of those who propagate new doc- 
trines. 

Whenever I cite the therapeutic method of M. Broussais, I 
speak of that which he pursued previously to 1816, and not of 
that which he may have adopted since that period. 

There is a degree of intensity which bids defiance to all the- 
rapeutic means; but the occasional failure of a particular mode 
of treatment does not authorize its rejection. If emetics and to- 
nics are at the present day justly opposed as remedial measures 
in adynamic fever, the opposition to them does not arise from 
the fact that they do not always cure, but from the circumstance 
of death occurring in most cases, notwithstanding their employ- 
ment, and farther, from the consideration that they often 
hasten the appearance and favour the progress of what has hi- 
therto been named adynamy. Since, on the contrary, this ady- 
namy occurs but rarely in the course of gastro-enteritis and 
other phlegmasia under the influence of antiphlogistic measures, 
we must not regret the latter, because they do not always pre- 
vent the disease, nor cure it when it manifests itself: a sufficient 
cause for preferring these measures is found in the fact, that the 
number of cases preponderates in which they arrest incipient or 
cure confirmed adynamy. Let us now consider the treatment 
proper in cases of manifest adynamy. 

When under the influence of powerful causes, or a very strong 
predisposition, usually in consequence of aggravating circum- 
stances, such as errors in diet, and the employment of tonics and 
stimulants, the leading adynamic symptoms manifest themselves, 
such as smallness of pulse, stupor, prostration, supine decubitus, 



; 



ADYNAMIC FEVER. 225 

must we commence the employment of antiphlogistics, if we 
have not hitherto employed them? and if we have already had 
recourse to them, must we continue their exhibition? Theory 
and experience unite in deciding these questions in the affirma- 
tive, since we every day observe the cessation of these symp- 
toms under the antiphlogistic treatment, even when they have 
attained a high degree of intensity. 

But the lessons of experience cannot be committed to paper; 
it is difficult to lay down general rules, because the cases to 
which they must be applied vary infinitely, and because a long 
period is certainly still to elapse before the point can be marked 
with precision, where we must desist from the farther employ- 
ment of antiphlogistic measures, and especially of blood-letting. 
The consummation of our knowledge upon the subject, can only 
be affected by the publication of the experience of enlightened 
practitioners on this important point of therapeutics. Of all 
the parts of the new pyretological doctrine, this, doubtless, is 
the one, the perfecting of which is most worthy of our assiduous 
endeavours. 

It is more easy to prevent adynamy, or to arrest it in its inci- 
pient stage, than to cure it after it is developed. Hitherto, the 
state of the pulse, of the muscular forces, and of the intellectual 
faculties, have exclusively occupied the attention of practitioners, 
and the indications were derived solely from these three sources: 
at the present day, the symptoms arising directly from the dis- 
eased organs, must be the chief objects of our attention. Thus 
when, notwithstanding a well directed antiphlogistic treatment, 
or when, under the influence of a tonic treatment, adynamy ma- 
nifests itself, we must study with care the state of the gastric 
passages, of the liver, the uterus, in a word, of the organ primi- 
tively affected. If the local signs of the phlegmasia of this or- 
gan continue, we must persevere in the employment of antiphlo- 
gistic measures. The propriety of this plan was perceived, not- 
withstanding the darkness of their theories, by the physicians, 
who, from the time of Galen to that of Pringle and Bouvart, 
recommended blood-letting in putrid fevers, when they were 
accompanied with signs of excitement. This advice was too in- 
definite to subserve any useful purpose. Bleeding should not 
be prescribed in this vague manner: in the choice and continu- 

29 



226 PHYSIOLOGICAL PYRETOLOGY. 

ance of antiphlogi sties we must be guided by the remarks which 
have been made in the preceding chapters, concerning inflamma- 
tory, gastric, or mucous fevers. Thus, whatever be the adyna- 
mic symptoms, the signs of cerebral congestion indicate the ap- 
plication of leeches to the temples, or to the ankles — bleeding 
from the foot, pediluvia and refrigerants to the head. Oppres- 
sion, frequency? and largeness of respiration, when joined to 
fulness of the pulse, even when it is slow and, as it were, em- 
barrassed, render it necessary to take blood from the arm; red- 
ness of the edges of the tongue, its dryness, :.::d sensibility, 
manifesting itself by groans, cries, or involuntary movements, 
when pressure is made upon the epigastrium, oblige us to repeat 
the application of leeches to this part of the abdomen. V 
to the adynamic symptoms are joined diarrhoea, we must, in 
most cases, apply leeches to the anus. In a word, we must obey 
the indications derived directly from the primitive phlegmasia, 
as though the adj-narmc symptoms did not eari 

These remarks apply to the cases in which the signs of the 
inflammation, which is the focus of all the symptoms, continue 
to manifest themselves in the midst of the adynamic symptoms. 
Here, let me repeat it, antiphlogistic measures are preferable, 
and are alone appropriate to the nature of the disease. Here, 
there are no exceptions, and no other modifications than those 
necessitated by the idiosyncracy of the subject, and the circum- 
stances in which he is placed. 

When the signs of local irritation have ceased, and the adyna- 
mic symptoms continue alone, when the latter manifest them- 
selves in a very alarming manner, and when we have no infor- 
mation with regard to the commencement of the disease, what 
conduct must we pursue? 

When the signs of local irritation cease entirely, the ai 
mic symptoms generally diminish in intensify. I: is then un- 
necessary, and it might be prejudicial to persevere in the treat- 
ment which has been adopted; the abstraction of blood should 
then be discontinued, and, in proportion as the state of the pa- 
tient becomes meliorated, we may change from a severer diet 
and the use of emollient -drinks, to light broths, and gradually 
to a substantial regimen. Let it be remembered, that even a 
light broth given too soon, when adynamy has been the result 



ADYNAMIC FEVER. 227 

of gastro-enteritis, may occasion the sudden renewal of all the 
adynamic symptoms, or prolong the continuance of those which 
remain. This fact forms one of the strongest proofs in favour 
of the new vtews of the nature and seat of adynamic fever. 

When, notwithstanding the diminution and even entire cessa- 
tion of the symptoms of local irritation, those attributed to ady- 
namy persist, we must not still renounce the hope of saving the 
patient, nor anxiously resort to the exhibition of tonics. Mild 
restoratives are in this case to be administered, and their result 
watched: if they appear to contribute to the disappearance of the 
adynamic symptoms, the more pleasant aromatic infusions may be 
prescribed with advantage; afterwards wine mixed with water, 
and, finally, mild bitters, when the tongue and stomach have 
returned to their natural state. This weakness almost always 
diminishes with rapidity, when the digestive passages properly 
perform their functions. It is only during convalescence, 
and when bitters are not disgusting to the patient, that we can 
prescribe them. The same remark may be made with regard 
to wine; we must consider the inclination of the patient: when 
he really has a desire for it, not occasioned merely by the wish 
to regain more rapidly his strength, this manifestation of the 
wants of nature must be attended to. Let it farther be remarked, 
that aromatic infusions, bitters and wine, cause the renewal of 
the adynamic symptoms when they are given too soon or too 
copiously. 

If it be inquired at what period broths, and tonics may be 
given, I shall answer, that none but physicians who contemplate 
diseases only in the closet, endeavour to point out the days for 
the employment of particular remedies, except in the case of 
intermittents. 

Let every physician become deeply impressed with the views 
which should regulate the treatment of adynamic fever, and he 
will soon acquire upon this subject the practical light which per- 
sonal experience alone can give, and which cannot be communi- 
cated. On the whole, there is certainly greater danger in has- 
tening the employment of nourishing articles and tonics, than 
in delaying too long their exhibition. When the physician is 
called to a'patient who has been suddenly attacked with ady- 
namic symptoms, with whose previous state he is unacquainted, 



228 PHYSIOLOGICAL PYRETOLOGY. 

without attempting to obtain from him information which he is in- 
capable of giving, for I suppose him affected with a stupor which 
does not permit him to answer, and almost annihilates all evidence 
of sensibility, he must examine him with care, judge of the state of 
the brain from that of the conjunctiva and the nostrils, of that 
of the stomach from the tongue, the mouth, and the skin, and by 
the effect of pressure upon the epigastrium; of the intestines, by 
the existence of diarrhoea or constipation: these signs, silent 
witnesses of a profound but latent lesion, being examined with the 
greatest solicitude, our conduct must afterwards be regulated by 
the result of this examination. The relative frequency of the 
irritations capable of giving rise to the adynamic symptoms and 
the different character impressed by each of them on these symp- 
toms, must be remembered. The chances of success are in 
these cases less numerous, as our method of proceeding must be 
based, to a certain extent, upon presumptions and approximate 
calculations. Precisely on account of the difficulties presented 
by such cases, is it important that they should not be abandoned 
to a blind empiricism, recommending the indiscriminate employ- 
ment of tonics. 

Finally, and this i3 the point most necessary to be understood, 
what must be done when the face is cadaverous, the pulse small, 
slow, scarcely sensible, the skin cold, covered with a clammy 
sweat, generally diffused over the body, or at least affecting the 
upper parts, the body inert and completely abandoned to its 
own weight, the eyes dull, and, as it were, covered with dust, the 
conjunctiva injected with black blood, the nostrils colourless, 
the tongue devoid of redness, natural in aspect, without any- 
coating, not dry, even pale, with the gums and the lips in the 
same state; finally, when, on pressing the epigastrium, the patient 
exhibits no signs of remaining sensibility? Certainly, if the tonic 
treatment be ever proper, it must be in such cases. Every 
physician, on witnessing such a state, is tempted to have recourse 
to stimulants, and there are few who do not anxiously resort 
to them; nor can they be censured, for it is difficult to remain an 
inactive spectator of such a condition, and it is not diet or emol- 
lient drinks that can here avail. But what advantage in general 
can we expect to derive from broth, bitters, quinine, the acetate 
of ammonia, camphor or ether? 



ADYNAMIC FEVER. 229 

Sometimes we observe a transient excitement of the heart; the 
pulse is accelerated without becoming fuller or stronger, the 
skin becomes hot and dry, the tongue also resumes the redness 
of the edges, and becomes dry, the patient groans when the epi- 
gastrium is pressed, or when he is moved: sometimes he opens 
his eyes, and seems to recognise those around him. But these 
favourable appearances soon cease, and the patient again sinks 
never to rise. 

Tonics sometimes appear to dispel the stupor, reanimate the 
circulation, and restore the functions of the stomach. In this 
case the gastro-enteritis had ceased before the diminution of the 
adynamic symptoms. The inflammation, extinguished in the 
stomach and the commencement of the small intestines, existed 
only towards the termination of the latter; the cerebral irrita- 
tion had not become irremediable; by stimulating the stomach, 
the equilibrium of action, without which life must cease, is re- 
established between the encephalon and this viscus. Here to- 
nics act as derivatives, and the result of the derivation is the re- 
establishment of cerebral action, as well as of that of the heart 
and stomach. 

Unwilling to evince an uncompromising hostility to princi- 
ples, when they do not involve any practical mischief, I am not 
averse to grant that in some adynamic fevers, the brain falls se- 
condarily into a' state of astheny, and that under these circum- 
stances, bitters and aromatics applied to the stomach act directly 
as tonics. But it is very necessary to be fully aware of the dan- 
ger inseparable from the premature employment of these means, 
of their inutility in most cases, and the absurdity of recommend- 
ing their indiscriminate employment in all adynamic fevers and 
in all their stages. 

In a word, I believe that the number of cases in which there 
is astheny of the brain and in which tonics are efficacious, is to 
the number of cases in which there is irritation of the viscus, 
and in which tonics are contra-indicated, as one to a hundred. 
I would ask those of my brethren who are tempted to condemn 
this proposition, to say whether they have had opportunities of 
observing several adynamic epidemics in different countries of 
the north and south, and whether they have methodically em- 



230 PHYSIOLOGICAL PYRETOLOGY. 

ployed antiphlogistic measures in a great number of eases of this 
nature. 

It will be observed, that, if I limit greatly the number of cases 
in which tonics may be useful in adynamic fever, I do not en- 
tirely banish them from the treatment Perhaps, indeed, it will 
be found that I have not been sufficiently rigorous in limiting 
their employment. In a wide-spread epidemic, the physician 
of a hospital may visit one hundred patients every day: consi- 
dering ten days the mean duration of the disease, he will see 
300 in a month: according to my estimate, then, he will cure, 
during this period, three patients by tonics. I mean three pa- 
tients who have arrived at the last stage of adynamy: now, every 
one knows, how limited is the number of recoveries from this 
condition. With regard to other cases, it is useless to repeat 
what has already been said with respect to the utility or disad- 
vantage of tonics; but I should here remark, that the patients 
who escape both the dangers of the adynamic fever, and of to- 
nics administered too soon, do not recover except after formida- 
ble symptoms, which sometimes continue for more than three 
weeks, and that they often retain chronic gastritis, known by the 
name of weakness of the stomach and generally treated as such, 
that is aggravated and perpetuated by the exhibition of the same 
tonics. • 

I think it unnecessary to dwell upon the manner in which to- 
nics were formerly administered in adynamic fever, since I am 
persuaded that, when given in this manner, they cause the loss 
of the patient, or at least aggravate his danger and retard the cure. 
During convalescence they must be exhibited with extreme cau- 
tion: the most feeble doses are the most efficacious; they favour 
the digestive process without renewing the irritation. The sul- 
phate of quinine is in this respect a valuable medicine. I have 
employed it with success in the dose of a grain once, twice, three 
or four times a day, in convalescence from certain cases of gastro- 
enteritis and arachnitis, which had been accompanied with symp- 
toms of stupor, and required the repeated abstraction of blood. 

The advantage derived from tonics in a small number of cases 
does not prove, as has been asserted, that adynamic fever is 
owing to debility; this advantage may be disputed: but, if it be 
admitted, nothing authorizes us to determine with regard to the 



ADYNAMIC FEVER. 231 

nature of a disease from the medicine which relieves it; thus I 
have not availed myself of the efficacy of antiphlogistic mea- 
sures in adynamic fever, to prove its dependence upon inflam- 
mation. 

This pretended proof falls to the ground, when we reflect that 
every day evinces the possibility of curing diseases of the same 
nature by remedial measures of totally opposite characters. 

The state of the skin deserves particular attention in adyna- 
mic fever; it is to this tissue that we can without much danger, 
attempt to provoke a derivation, when the irritation is beginning 
to cease. If this measure does not always succeed, at least it 
should be tried in many cases, and its effects will sometimes be 
satisfactory. 

All authors coincide in recommending an exceeding attention 
to cleanliness, as one of the most certain means of success in this 
fever. It is perhaps more necessary in these than in any other 
diseases, since the excrementitious particles, at the same time 
that they irritate the skin by their prolonged contact, may se- 
cond-the effects of pressure in causing the development of an in- 
flammation, succeeded by gangrenous eschars, which generate 
gases, capable of adding to the danger of the patient by their 
introduction into the digestive and respiratory passages. Thus 
the greatest care should be taken, not only to renew frequently 
the air of the apartment and change the linen frequently, but 
also to wash the whole surface with a mixture of equal parts of 
hot water and vinegar. These lotions, which should be imme- 
diately succeeded by the application of very hot cloths, keep up 
the action of the skin, and diminish the acrid sensation it occa- 
sions, when touched; they are particularly useful when the skin 
is clayey and dry; we should not have recourse to them when 
the skin is burning; or if these lotions should then be prescribed 
they should be made with water of a mean temperature, which 
causes no sensation of either cold or heat. 

In vain might we attempt to do more to cause a derivative ir- 
rition in this tissue, before the diminution of the primitive irri- 
tation: as long as the latter remains intense, it cannot yield to 
the development of an external irritation; all that can be done is 
to use dry frictions, conjointly with the lotions, and renew them 
several times a day when the skin is not very hot. But when 



232 PHYSIOLOGICAL PYRETOLOGY. 

the local phenomena of inflammation of the digestive passages, 
of the lungs, the uterus, .the peritoneum, the bladder, &c. have 
ceased, if not completely, at least in a great measure, we may- 
employ baths, sinapisms and vesicatories. 

Baths tend to dissipate the gastro-intestinal irritation and pre- 
pare the skin to receive the impression of rubefacients. They 
should be administered at a mean temperature. For some years 
past, many physicians of Paris, after the example of English, 
American, and Italian practitioners, have poured cold water 
upon the sick while in the most profound stupor. This bold 
proceeding has sometimes been justified by the successful re- 
sult; that is to say, all the patients have not expired; sometimes 
even the circulatory and cerebral functions have resumed their 
activity to the great astonishment of the attendants, and the pa- 
tient has recovered. Such instances of success, to which may be 
opposed so many cases of failure, have a greater tendency to in- 
crease the number of victims to the disease than to enrich the 
domain of therapeutics. This measure must be left to adventu- 
rous practitioners, whose whole life is a series of experiments 
upon the patient injudiciously committed to their charge. 

Of all the means used with the view to establish an afflux to 
the skin, sinapisms are the most eligible. We have the ad- 
vantage of provoking the swelling of the sub-cutaneous cellular 
tissue, and consequently of imitating the morbid fluctuating move- 
ment better with them than with vesicatories, and they have not, 
like the latter, the inconvenience of irritating sympathetically the 
urinary passages. They often produce good effects when they 
are not applied until the inflammation has declined ; in ge- 
neral, they are not permitted to remain for a sufficient length of 
time; they should frequently be continued for five or six hours. 
They are generally applied to the feet or ankles: their action is 
rendered more prompt and durable by placing the feet in warm 
water for some minutes previously to applying them. Sina- 
pisms sometimes determine vesication, and even inflammation of 
the subcutaneous cellular tissue; this inflammation may occasion 
a suppuration, which is not always devoid of danger: these bad 
effects, however, are not apt to occur when a sufficient quantity 
of blood has been abstracted before resorting to this revulsive 
measure. 



ADYNAMIC FEVER. 233 

Blisters, which most physicians consider it their duty to pre- 
scribe as a matter of course in the last period of adynamic fever, 
should be classed among the means established by custom rather 
than those sanctioned by observation. Applied before the cessa- 
tion of the principal local symptoms of inflammation, they are 
injurious, particularly when the inflammation is seated in the 
stomach and intestines. 

Applied too late, they no longer produce the desired effect, 
and may then be considered rather as means calculated to throw, 
light upon the issue of the disease than as remedial agents. It 
is, however, far from being the case that the failure of rubefac- 
tion is, as has been asserted, a certain sign of the approach of 
death. 

Sinapisms often effect what blisters are incapable of producing, 
and, should a permanent effect be desired, we have only to pro- 
long the time of their application, while it is often very difficult 
to keep up the inflammation, produced by blisters, or at least 
this can only be accomplished with much suffering. The time 
is passed when it was thought that suppuration was more bene- 
ficial than simple rubefaction prolonged or repeated. 

We must in general beware of expecting too much from ru- 
befactions in adynamic fever. When inflammation has disor- 
ganized the tissues, in vain does it appear to become extinct: in 
vain is the brain actively stimulated by the irritation of the skin; 
its action ceases because an important viscus, to which it was in- 
timately related, no longer fulfils its functions, and no longer acts 
upon it. It is, under these circumstances, at least useless to resort 
to the employment of fire, according to the advice of some 
practitioners. At the present day such an experiment would be 
more injudicious than formerly, since it has been proved by ac- 
curate researches that a burn of the skin may determine a violent 
gastro-enteritis. If we reflect that the inflammation of the parts 
on which the body lies, such as the region of the sacrum and 
great trochanters, never contributes to the restoration of the pa- 
tient, we shall be induced to believe that an excessive inflamma- 
tion occasioned by any other means and followed by eschars, can- 
not be more advantageous. 

When, notwithstanding the strictest cleanliness and other pre- 
cautions against the formation of eschars, we observe the com- 
mencement of inflammation from pressure, we must, as far as 

30 



234 PHYSIOLOGICAL PYRETOLOGY. 

possible, place the patient in the most faYourable position, and 
trash the irritated parts with a solution of acetate of lead. If 
an eschar forms, emollient applications are proper, and if the in- 
flammation necessary for the healing of the ulcer be wanting, 
the part should be dressed with lint, covered with an irritating 
ointment. From the occasional necessity :r resorting to this 
method to hasten the cure of these ulcers, it has been concluded, 
that ulcers of the intestines might equally require the internal 
use of tonics. Titis is a mere presumption, to which, I think, 
sufficient deference is paid, when we allow our patients to use 
mild tonics during convalescence, when they decidedly c 
them, and not in obedience to the Brunonian theories. 

The genius of sympathetic medicine has found a fertile field 
for its display in the treatment of adynamic fever. When both 
the seat and nature of these diseases were unknown, it was na- 
tural to combat each of the symptoms separately, or, at least, it 
was hardly possible to proceed in any other manner. At the 
present day, the treatment should be directed exclusively ?: ir.s: 
the primitive lesion. When this plan is pursued, that insupporta- 
ble dryness of the mouth is not observed which torments patients 
treated by tonics; it is, however, sometimes proper to moisten 
their lips with the juice of an orange, or some other acescent fruit 
Retention or suppression of urine is seldom observed under the 
antiphlogistic treatment: if the former take place, we must 
practise catheterism several times a day, but beware of leaving the 
instrument in the urethra and bladder, as is often done; as this 
might occasion cystitis, or aOgme.t it if it alreacv t:: r :t:i. :-.:;:. 
thus add to the disorder of the viscera. Cold drinks copiously 
taken, when the state of the stomach permits it, are sufficie: 
remedy the irritation of the kidneys; nevertheless, when it is 
considerable, it is proper to apply leeches to the loins or perineum. 
C :: .^tipation should never be combatted by purgatives, or even 
by laxations in adynamic fever; it ceases with the irritation: it is 
only proper to prescribe lavements to evacuate the great intes- 
tine. Diarrhoea requires only the same measures as the irrita- 
tion, of which it is the symptom; it is much more common when 
tonics are used, than when the antiphlogistic treatment is em- 
ployed. The remarks made upon this subject, under the head 
of mucous fever, may be applied to the present case, 

Meteorism, of which an attempt has been made to establish 



ADYNAMIC FEVER. 235 

three or four species, depends sometimes on the distention of 
the intestines by a gas, abundantly formed in all cases of the 
functional disturbance of these viscera, and sometimes in in- 
flammation of the peritoneum, whence results a disengagement 
of gas in the cavity of this membrane. To combat the inflam- 
mation is then the best means of preventing meteorism, and 
when it occurs, the application to the abdomen of a bladder, partly 
filled with water, of a temperature inferior to that of the skin, is 
the best measure we can employ. It is not necessary to employ 
ice; excessive cold might be hurtful: it is sufficient to keep up 
a moderate degree of cold. 

Hemorrhages, occurring at the commencement, or during the 
period of the intensity of diseases, called adynamic, should ne- 
ver be repressed; we are not, however, to promote them. The 
quantity of blood which flows is sometimes enormous, without 
any increase of debility, or, at least, if it increases, we generally 
observe a cessation of all the symptoms of irritation, as well as 
of those of adynamy : the patient is aroused from his stupor, and 
nothing remains but weakness, which it is not difficult to reme- 
dy, since he immediately becomes convalescent. 

The hemorrhages which supervene in the last stages of ady- 
namic fever, are not, in like manner, favourable. The blood 
frequently flows until death, resisting all attempts to arrest it. 
Neither plugging, refrigerants, nor astringent lotions, prepared 
with acids or vegetable substances, containing tannin, have usu- 
ally any effect in averting this impetuous effusion of blood attri- 
buted to weakness. Let the advocates of this etiology explain 
why the strongest tonics are powerless against these hemorrha- 
gies, which they consider passive. They, doubtless, hasten the 
fatal termination, by the excessive loss of blood, but it is no less 
eertain, that they are the consequence of an obstinate afflux of 
blood to the organ in which they manifest themselves, and which 
we as yet possess no effectual means of opposing. The same re- 
mark may be made with regard to the excessive sweats which 
manifest themselves in some cases of adynamic fever. Pru- 
dence requires us to neglect nothing which can arrest, at the 
commencement, a disease capable of producing results so formi- 
dable. 

The abundant and almost continual sweats, which supervene 
in adynamic fever, merit particular attention. When they are 



236 PHYSIOLOGICAL PYRETOLOGY. 

accompanied with paleness of the skin, slowness and infrequen- 
cy of the pulse, reduced temperature and pale tongue, it is pro- 
per to give a few grains of the sulphate of quinine. 

Since adynamic fever is only the highest degree of synochal, 
gastric, or mucous fever, convalescence requires no other mea- 
sures than those employed in these fevers. I have pointed out 
the cases in which mild tonics may be used. This precept must 
not be too far extended, if we would avoid a tedious convales- 
cence, in which we know not what treatment to resort to. An 
infallible rule is to discontinue all tonics, when they do not in a 
few days procure a gradual amendment of the digestive func- 
tions. 

When inflammation has arrived at such a degree as to give 
rise to adynamic symptoms, the organism is profoundly modified; 
the system has lost much of its materials; we must, therefore, 
prescribe such nourishing articles of diet as the stomach can sup- 
port, with the view of promptly restoring the strength. In this, 
perhaps, more than any other disease, should we remember that 
what nourishes is not what is eaten, but what is digested. 

Adynamic symptoms are not the only ones which have been 
attributed to weakness: there are others which, ascribed without 
more reason to the same cause, have been grouped under the 
name of ataxic fever, as will be seen in the following chapter. 

M. Louis recommends bleeding in the acute stage of the ty- 
phoid affection: if the subject be weak, twelve ounces are suffi- 
cient; otherwise double the quantity may be taken in the first 
ten or twelve days. According to him, the utility of local 
blood-letting is not so well established. This is one of his pecu- 
liar opinions, and is opposed by general experience, except in the 
case of young and plethoric individuals. He opposes blood-let- 
ting beyond the twentieth day ; no one resorts to this measure at 
so advanced a period of the disease. He thinks that at this pe- 
riod a decided exacerbation of the disease is observed when stimu- 
lants are not resorted to. He believes that the drinks cannot be 
too abundant; this is an error: it is rarely necessary to exceed 
two or three pints in a day. The ingestion of so great a quan- 
tity of fluid is avoided by making the patient drink frequently, 
and but little at a time. Here he is influenced by the inflamma- 
tory character of the disease, contrary to his own wishes; for he 
compares the effects of drinks in the present case to that of ca- 



ADYNAMIC FEVER.' 237 

taplasms and emollient baths in inflammation of the external 
parts. It is likewise as internal fomentations that he recom- 
mends lavements when the stools become very numerous. Thus 
far the treatment of M. Louis is that of the phlegmasia?, but he 
soon returns to the old theory, and whenever the heat becomes 
moderate, the prostration considerable, and the meteorism disap- 
pears, or nearly so, when nothing indicates a lesion of the mucous 
membrane of the stomach, and weakness is the principal symptom, 
he advises a recourse to tonics, which are to be exhibited cautiously 
at first, lest there should be any error of diagnosis, with regard to 
the stomach: for this purpose, an effusion of bark may be adminis- 
tered by the mouth, and in lavements; afterwards, if these mea- 
sures produce no bad effects, recourse may be had to the sul- 
phate of quinine, in doses of eight, ten, twelve, or twenty grains, 
in an aromatic or gummous potion, with the syrup of quinine 
for drink, and the vinous lemonade; if the diarrhoea be abundant, 
tonic lavements, such as those of bark, and even simarouba, are 
to be used. " Tonics, if they are really indicated," says M. 
Louis, " produce their good effects in a short time; so that if in 
four or five days after their employment, we do not perceive 
a sensible melioration, we must discontinue them; since, in that 
case, there is reason to fear an error of diagnosis, and that 
some disorder opposes their employment." To appreciate the 
advantage which M. Louis, or rather the physicians in whose 
wards he collected the materials of his book, derived from this 
tonic plan, we must remember that he witnessed the death of a 
third of the patients thus treated^: this consideration will excuse 
our entering into a more minute account of the method which 
he proposes. 

Let it not be said, we repeat it, that the anatomical researches 
of M. Louis are devoid of utility; for if they have not convinced 
their author of the frequent inefficacy, and more frequent danger 
of tonics in adynamic fever, they have, at least, rendered this 
truth palpable to the attentive readers of his book. 



'4-te PHYSIOLOGICAL PYRETOLOGY. 



CHAPTER VI. 



0/ .f;--.r:'; Fisir. 

Axo jtg fevers there are some which exhibit the most alarming 
symptoms formerly attributed to putrescency of the humours, and 
others which terminate in death, in the midst of the most perfect 
security inspired by the normal condition of the pulse, temperature 
and urine. The latter, for which Fernel retains the name of malig- 
nant fevers, assigned to them by the ancients, have been called 
nervous fevers, slam nervous fevers by Willis and Huxham. Stoll 
unites, under the name of putrid fever, both the putrid and malig- 
nant of Fernel: the same classification was adopted by Cullen, who 
thought that a more proper name was typhus, extending conside- 
rably the signification of this word, at present restricted to desig- 
na:e certiii ej: iff ::".:■: iV-'irs. vrLi'iL ?..:e am: mi: ■:•=■: :v 2.\?.zzlLzz 
symptoms, and which carry off great numbers. J. P. Frank 
adopted the name of nervous fevers to designate the putrid fevers 
of Stoll: this name was not new: if however e vinced in :z:~: ::::: 
of c..i*:zzizz a =e ?y ::■ :he diseiir. 

A word which Hippocrates happened to make use o£ and which 
was repeated by Sydenham, (ataxia) induced SeDe to establish a 
lever with nervous symptoms without any alteration of the blood, 
the bile or the phlegm; that is to say, without the symptoms at 
present called angiotenic, gastric, mucous, or adynamic. After his 
example, Pinel recognised a simple ataxic fever, capable of being 
complicated with other fevers and with fnflammafinn. 

We have seen that to create the fever called adynamic, noso- 
logisfs have only grouped the symptoms which appear when irri- 
tation with sympathetic phenomena are not arrested, and more 
especially when they are aggravated by stimulant. If they have 
committed an error of great magnitude in ascribing these symp- 
toms to debility, their description is at least conformable to na- 
ture,. =.:.:: L: sLr.p:T ^ ::„t;:;;i :::::::': :z p htr.:.Y.tr.:-, ii-:ime-i Lroiri 



ATAXIC FEVEit. 339 

those which precede and accompany them: these morbid phenome- 
na, however, are found in certain patients, if not altogether in the 
order pointed out by the nosologic, at least such as he has de- 
scribed them. 

In creating the order of ataxic fevers, nature has not been 
by any means so strictly followed. All is artificial in the de- 
scription given by Selle and Pinel: the fever, as described by 
them, is a series of antitheses, in which the most formidable symp- 
toms arc made to alternate with the most insignificant, without 
any attention to order. These authors design to paint, not a disease, 
but a host of diseases, having this character — that they have no- 
thing regular in their progress : they have designed to give an 
exact description of the disease by amassing and exhibiting, side 
by side, all the febrile symptoms that are ever encountered. 

Hopeless of exhibiting separately all the shades of adynamic fe- 
ver, they have confounded them in a single description, all the fea- 
tures of which are contradictory. They deem it sufficient to admit 
a simple ataxic fever absolutely imaginary, if by it be meant the de- 
scription which we shall present to the reader, and complicated 
ataxic fever, which they have not described. 

The characteristic symptoms of ataxic fever are as follows: 

Derangement of the relations existing between the functions 
in general, and in particular of those existing between the different 
parts of a single system or apparatus of organs: tongue clean or 
covered with a whitish coating, moist or dry; thirst deficient or 
excessive, sometimes a dread of water; deglutition embarrassed or 
even impossible; sometimes a sense of strangulation, vomiting either 
spontaneous or provoked by the slightest causes, obstinate diarrhoea 
or constipation, pulse different in different parts of the body, and 
often in the same artery alternately large and small, strong and 
weak, frequent and unfrequent, regular, irregular or intermittent, 
syncope, transient appearance of local congestion, momentary red- 
ness and paleness of the, skin, alternating with each other and dis- 
tributed in an irregular manner, respiration alternately easy and 
difficult, frequent or slow, large or small, continued or interrupted; 
sometimes cough, hiccough, sneezing, involuntary sighing and 
laughter; the heat more or less elevated than in a state of health, 
unequally distributed and alternately augmented and diminished, 
with transient chills, rapid, contrary and often alternating changes 
of the secretions and exhalations, cutaneous transpiration sup- 



240 PHYSIOLOGICAL PYRETOLOGY. 

pressed or augmented and often partial, cold or hot, clammy or 
watery, excretion of urine suspended, difficult and painful or very 
abundant; urine generally limpid, sometimes depositing a sediment 
without the least remission of the symptoms, involuntary shedding 
of tears, or dryness of the conjunctiva. An obtuse state, or an ex- 
cessive sensibility of the organs of sense, the looks wandering, 
somnolence or insomnolence, vertigo, coma, delirium or sound 
state of the intellect, no knowledge of those around, and igno- 
rance of the serious character of the disease, indifference on this 
subject, or continued inquietude, sadness or despair, quick and 
short answers, voice shrill, stammering or aphonious, pain at the 
occiput, in the back, in the limbs, thehypochondrium; a total in- 
sensibility, carphology, prostration of strength without abundant 
evacuations, general or local tremors, subsultus tendinum, con- 
vulsions, universal or partial paralysis, symptoms of epilepsy, of 
catalepsy, of tetanus, &c. 

These symptoms are nearly equal in each organ, or they are 
greater in some particular organs. 

We shall now endeavour to throw some light on this confused 
mass of symptoms. Among all the phenomena, which are the 
most remarkable, serious, and alarming? They doubtless are 
those which manifest themselves in the nervous system: these 
symptoms may be divided into two series: in the first, I class 
excessive sensibility of the organs of sense, wandering looks, in- 
somnolence, vertigo, delirium, pains in the occiput, back, limbs, 
and hypochondria, jactitation, carphology, stammering, ge- 
neral and local tremors, subsultus tendinum, symptoms of 
tetanus, of catalepsy and epilepsy, hiccough, sneezing, and 
involuntary laughter. All these symptoms appear to me to 
be evidently referrible to the nervous system: the brain being 
the point to which the sensations and internal impressions tend, 
as well as the point of departure of the volitions and the seat of 
that singular action which unites all the vital actions, it is natural 
to conclude that thisviscus is the principal source of the symptoms, 
or at least that they cannot occur without some lesion, secondary 
or primitive, of this organ. I think it impossible not to perceive 
in these symptoms so many unequivocal symptoms of irritation. 
Shall it be said, that the insomnolence, delirium, and tremors are 
owing to weakness? This cannot be imagined, for the brain is in 
a state of greater excitement during nocturnal insomnolence, than 



ATAXIC FEVER. 241 

while awake during the day, and this viscus must of necessity be 
sur-excited by some organ, or be primitively irritated to prevent 
its yielding to sleep, after prolonged waking. Delirium may oc- 
cur in subjects who have experienced great loss of the materials of 
their systems by hemorrhage or abundant suppuration. If deli- 
rium be the result under these different circumstances, the rea- 
son is, that the abstraction of blood occasions a sudden but irre- 
gular sur-activity, because the relation of this organ to the other 
viscera is no longer the same. As to the stammering and trem- 
bling, they equally occur in weak subjects, but they do not, on 
this account, depend upon debility; unless we attribute to this 
cause Saint Vitus' dance, which generally occurs in very irrita- 
ble subjects, whose nervous system, it may thence be concluded, 
is in a state of sur-activity. 

The second series of nervous symptoms is composed of an ob- 
tuse state of the senses, of somnolence, coma, indifference to 
surrounding objects, and even to life, of aphonia, of total insen- 
sibility, of prostration, and universal or partial paralysis. These 
symptoms appear at the first glance to be attributable to weak- 
ness. It is certain that most of them indicate a suspension or 
diminution of the functional activity of a part of the nervous sys- 
tem, and particularly of the brain. But all these symptoms are 
observed in arachnitis, in hydrocephalus, in encephalitis and in 
cerebral hemorrhagy: they should, therefore, be attributed either 
to an inflammation of the brain or its membranes, or to an alter- 
ation of the texture of these parts, occasioned by an afflux of 
blood, and consequently by a very intense irritation, which im- 
pedes or abolishes the exercise of the functions dependent upon 
this organ. In this case, inflammation of the arachnoid and of 
the brain acts as all other inflammations, the first effect of which 
is to suspend or disturb the functions of the affected organs. 

Thus, it appears that the ataxic symptoms, which are observed 
in the nervous system are not owing to essential debility, and 
that every thing would induce us to consider the brain and its 
connexions as the seat of these phenomena. This proposition 
will acquire more certainty as we advance in the investigation 
of the nature and seat of ataxic fever. We shall not be censured 
for having separated the principal ataxic symptoms into two divi- 
sions. Pinel thought of this division. " These lesions," he 
says, " are far from being always referable to a state of domina- 



fhy = ::ljg:cal ?t?:it;l; :-t. 



tici :r z :-.zen=zi z: lie- ie=vz 15 z=r. zz..z=5: 
i==z::zi5 ire z:rr:e: :: 1 r_ : z r. ::~:: ::" ::::~=7." I: =117 :e 
farther remarked, that the symptoms of irritation are the most 
constant, that they often succeed those which appear to announce 
debility; that more frequently they accompany them. Wow, can 
:: ze 5-: = =o>r: m: lie :ti_i is :z lie fine ~:z::: ii : 5z.::e :■■: 
irrziiz:::. 11 i =511117 ? Tie 51 : M5zie:i:::=5 zidizi -.5 :.: le'iive 
that this organ is more subject to astheny of function than to a 
siize ::* z.:5i:zze i.5i=r=v. -ii.:-":. is 71:11:5 :.e~e: :e:iez.ez A: 
the commencement of ataxic fever, the weakness is only appa- 
rei: ; :: :s lie ezez: :: zerezrii .::.:• "..::. eve: " ;.er. :: nike.5 
its appearance without symptoms of irritation. At the termi- 
nation, the symptoms of debility depend on disorganization. To 
this remark of M. LaUemand, let us add the following descrip- 
tion, drawn by this professor, which will he of use in aiding 
= :i:z:::::e=5 ::. i->:zr-_:.z_z :ie >en. i:ree. =1: ezzezs ::' liz.e 
e:.::::.:'..: :r:.:i:::i. "•':„;"- g.rtf : se ;.; ihe =1:5: ziirizurisiiz 
pincneii ::' 1:1=: z iVe;. 

Tie i=r::::=5 ::" lie zzi.i ::: ne inzziici: =ie=i'z:::e = i- 
niies; i=e=i>e>r5 ex-.err.1ll7 :t = ii5:z = ::" :ie :e:e~z:-=. i:i::.:i5; 
that is to say, by symptoms related to the perception of external 
c:;ez:,5 :: lie ineLie:: 11 1 t : . : - 1—7 =izTez=e=i5. Tie 57=11:1=1.5 
c: :iiiini::.:i zz'ne zzi.i ::e5.e:z :~; — inner- 11:1:1.7 :i- 
r : 5-e £ :: 11:1 zziie:; ::.:>e zz':::.:i=:i 11: ih:>ec: zzi-iisi: zz.z 
=:5. ire i.ie~.5-e zzsirvri := i ==1=1=111. := ::* ne ir-2.zh.1-z:: 111 
:,'ie >e:zi: zi zeiezni lenzrriirr: "iiz^i i: iz: ii: ziei 
z:./.e ■ e=:e::z= z==iz==::i:zi ::'z:e zm=. "11:1:5-1 ii iri:'=.=iii> 
there is irritation of the brain without alteration of structure, and 
in cerebral hemorrhagy there is at first alteration without irrita- 
:":=. :i: :: .5 11.7 :i : :. =1=1=1 1 :.: ; 1 :■: lize z=i: = in: nere :.n 
be 5-::z.r5s:Tr".v zr:.::i:z = z.i: iz5irii=]:i=:=. Whe = 71^75:5 
rri:izi5 lie 571511::.: 57=17;: 115. zz 15 zinzse lie 
::.:5 izsrii i:e:eie5 :=zizz==ii:::i. zi zzisez :ei:e ::" 11 
c: :.!:•:. ^:.e: lie 57151111:1 57=:;:: =15 ire ~i::.::. lie 5.z-- 
and progressive course of the paralysis easily distinguishes that 
which is produced by cerebral hemorrhagy. We therefore have; 
Ii 1111=1111=11 :: lie i:::i=iiz. 5=i5=iz:.: 57=11=11=5 vri.i- 
c_: 11:1.75.5; 

In cerebral hemorrhagy, sodden paralysis without 
sympioi 



ATAXIC FEVER. 243 

In inflammation of the brain, spasmodic symptoms, slow and 
progressive paralysis, unequal and intermittent progress.* 

It is natural to inquire whether it be possible to carry the ana- 
lysis farther, and, from the symptoms which manifest them- 
selves, point out the part of the encephalon or arachnoid which 
is inflamed. M. Bouillaud thinks that paralysis of the organs 
of speech depends on the lesion of the anterior lobes of the 
brain,t and that of the inferior extremities on the lesion of the 
middle lobes, or that of the corpora striata; while, according to 
Laucerotte, MM. Foville, Pinel Grandchamp,J Lacrampe, 
Lousteau,§ and Carmeil,|| the latter is in consequence of an af- 
fection of the anterior lobes. According to them, paralysis of 
the upper extremities is the effect of a lesion of the optic thala- 
mi, or of the posterior lobes of the brain, while, according to M. 
Bouillaud, it results from a lesion of the junction of these lobes 
with the middle lobes, and even of the latter themselves. This 
author thinks that the seat of the lesion which gives rise to pa- 
ralysis of the muscles of the eye is yet unknown, and that the 
loss of the memory of words, or of the principal signs of our 
ideas, is owing to an affection of the anterior lobes of the brain. 

Were the doctrine of Gall well established, which it is far 
from being, we could, at the sight of a patient who believed him- 
self a god, or a pregnant woman, or who endeavoured to destroy 
every thing around him, immediately assign the precise seat of 
the disease; but this even Gall himself did not venture to do, 
lest post mortem examination might prove the falsity of his pre- 
dictions. Yet if we admit, in a general way, that his doctrines 
are based upon truth, delirium will result from a lesion of the 
circumvolutions, and, according to MM. Foville and Pinel 
Grandchamp, from a lesion of the cortical substance. 

* Recherches Anatomico-Pathologique sur VEncephale. Paris, 1822-3; 
in 8vo. 

f Traite Clinique et Physiologique de V Inflammation du Cerveau. Paris, 
1825, in 8vo. 

J Recherches sur le siege special des Functions due Systeme des Nerveux. 
Mars. 1823. 

§ Recherches des differ entes Functions de Systeme Nerveux dans les An- 
nates de la Med. 

|| De la Paralysie chez les alienes, Recherches failes sous la direction de 
MM. Royer Collard et Esquirol. Paris, 1826; in 8vo. 



244 PHYSIOLOGICAL PYRETOLOGY. 

As to those cases in which sensibility continues after muscu- 
lar motion has ceased, and those in which motion continues 
while sensibility disappears, they give rise to a question of 
great importance dependent upon anatomieo-physiological laws, 
not vet positively established. 

With regard to the arachnoid, MM. Parent and Martinet 
think that -the inflammation of the portion of this membrane 
which covers the convexity of the hemispheres occasions a dis- 
turbance, more or less sensible, but always evident, of the in- 
tellectual faculties, which is characterized by cries and vocifera- 
tion or loquacity, a slight incoherence of ideas, a change in the 
character, an embarrassment in expressing ideas; the derange- 
ment may reach a total cessation of the intellectual operation. 
The jactitation keeps places with the delirum, and ceases with it. 

The inflammation of the arachnoid at the base of the brain, is 
announced, according to these authors, by convulsive movements 
of the eye, strabismus, considerable dilation of the pupils, espe- 
cially in infants, in whom there is also failure of the intellectual 
faculties, with transient return of intelligence, while somnolence 
is entirely confined to adults; the special character of this par- 
tial phlegmasia of the tunica arachnoides is the complete or in- 
complete abolition of intellect; the other symptoms may arise 
from effusion. When the inflammation is confined to the ven- 
tricular portion of the arachnoid, which is an unfrequent occur- 
rence, it cannot be distinguished from that of the portion of this 
membrane, which covers the base of the brain. When the arach- 
nitis is general, there is a mixture of the symptoms which cha- 
racterize the inflammation of both the convexity and the base. 
This probably occurs in the greater number of ataxic fevers. 

M. Lenn thinks that suspicious respiration is the most frequent 
character of meningitis in infants, and that increased sensibility 
of the integuments of the trunk and great prostration announce 
inflammation of the corpus callosum, of the septum lucidum, or 
of the fornix.* 

* See his Recherch.es Anatr>mico-Pathologiques sur la Meningite Aigue 
des Infans et ses Principales Complications. Paris, 1525, in Svo. And the 
analysis by myself, published in the Journal Universal des Sciences Medi- 
cates, xxxix. p. 176 and xl. p. S3. D. Charpentier, De la Nature et du Traite- 
ment et V Hydrocephale Aigue (meningo-cephalite) des Enfans, Paris, 1S'29; 
in 8vjo. 



ATAXIC FEVER. 245 

It is to be desired, that the researches of practitioners be di- 
rected in such a manner as to confirm or modify these proposi- 
tions: to assent lightly to them would be to imitate the creduli- 
ty which has been too frequently exhibited in relation to the- 
rapeutics. Since the first publication of this work the science 
has been perfectly stationary. Observations confirmatory of these 
different opinions are yet wanting, and their publication, from 
time to time, is much to be desired. The present state of un- 
certainty will not cease until the physicians of the great hospi- 
tals and the considerable towns, draw up with care, for a series of 
years, a detailed history of all their cases, and publish the re- 
sult. 

M. Guersent is one of the few physicians of the present day, 
who, although well versed in clinical and anatomical researches, 
still admit an ataxic state without appreciable alteration of the 
encephalon. This opinion is the consequence of attaching no 
importance to a slight injection of the arachnoid, or to a small 
effusion, although it be of a gelatinous character. It is to be re- 
gretted that so distinguished a practitioner has not entirely 
thrown off the yoke of theories so unworthy of him. 

If we now proceed to an examination of the gastric symptoms 
of ataxic fever, we perceive that many of them are possessed 
of no value; but we find among them dryness of the tongue, ex- 
cessive thirst, vomiting, diarrhoea, constipation: now, all these 
symptoms announce/incontestably, irritation of the digestive pas- 
sages: enough has been said upon this point to render it unne- 
cessary to return to it. 

It is not necessary to prove that there is no spontaneous vo- 
miting, that is to say, vomiting without a cause. The sense 
of strangulation is one of the symptoms the least known, and 
yet one of the least equivocal of irritation of the stomach, the 
pharynx, the larynx, and perhaps of the arachnoid; besides, it is 
a painful affection, and therefore not dependent upon debility. 
Impeded deglutition arises from its being attended with pain, or 
from inaction or spasm of the muscles which perform this act. 
The remarks on paralysis and convulsion are here applicable. 
The horror of ivatcr, which is perhaps only a consequence of 
impaired deglutition, is of too unfrequent occurrence in ataxic 
fever to derive from it any weighty argument in relation to this 
fever. Finally, the researches of M. Frolliot prove that the 



246 PHYSIOLOGICAL PYRETOLOGY. 

three symptoms which have just been mentioned, announce in- 
flammation of the arachnoid and of the larynx in hydrophobia, 
a disease which presents the phenomena of ataxy in the highest 
degree, and which would certainly be regarded as ataxic fever 
by every practitioner who should observe the symptoms without 
knowing their cause. 

The different symptoms which have been mentioned, and 
which have their seat in the digestive organs, are sometimes 
wanting in ataxic fever. Must we hence conclude, that this ap- 
paratus is not affected? this opinion would frequently be dis- 
proved by post mortem examination. Or must we conclude that 
there is malignity in the disease? Certainly not; for what can 
be meant by such an attribute, assigned to a fever. All that we 
can infer is, that there is no lesion, or at least only a slight one, 
of the digestive apparatus, or that the principal symptoms cannot 
manifest themselves on account of the state of suffering of the 
brain, for we shall shortly be convinced that this organ suffers 
in every case of ataxic fever. On the whole, none of the gas- 
tric symptoms of this fever indicate astheny. We shall present- 
ly see, that the unequivocal symptoms of gastro-enteritis, which 
are not less frequent than the nervous symptoms, have been 
passed over in silence. 

It is principally upon the state of the circulation that the na- 
ture of ataxic fever has been made to depend. It is certainly 
most absurd to attribute to any other cause than irritation, the 
force, fulness, and frequency of pulse, observed in a great num- 
ber of ataxic fevers, particularly at the commencement. On 
whatever cause these diseases depend, these qualities of the pulse 
announce energy of the contractions of the heart; and therefore, 
if the disease be considered as resulting from weakness, it must 
be confessed that this organ does not participate in it When 
the pulse is frequent and quick, but small and weak, as it is ob- 
served in most of these diseases, particularly towards the termi- 
nation, the heart is evidently irritated, for quickness of pulse is 
an unequivocal sign of sur-excitation of this organ. But, at the 
same time, its contractions are less powerful; stimulated by the 
diseased organ, it precipitates its contractions till they can no 
longer occur: this is observed in cases of inanition, where the 
pain of the stomach and the want of nourishment, occasion rapid 
but weak contractions of the heart. At the termination of ataxic 



ATAXIC FEVER. 247 

fever, the pulse becomes slow, intermittent, and more and more 
small and weak when death is not remote. We have then rea- 
son to suspect astheny of the heart, but this astheny is not the 
whole of the malady: if this were the only affection, ataxy 
would not exist. Besides, it is not certain that smallness and 
even weakness of the pulse are an unequivocal index of weak- 
ness of the heart; since this is observed in a number of inflam- 
mations, even when there is no affection of the brain. It would 
be temerity to judge of the nature of a disease from a single 
symptom of so uncertain a character. In syncope, there certain- 
ly is suspension of the action of the heart, but as this takes place 
in many operations at the moment of the first incision, even 
when the patient has no apprehensions, it cannot be a certain sign 
of primitive astheny of the heart. 

The slowness of pulse, often remarkable in ataxic fever, is one 
of the phenomena most deserving of attention; its frequent co- 
incidence with congestion, cerebral hemorrhagy, and encephali- 
tis, proves that it is not a symptom of general weakness, and 
that it would be more rational to attribute it to a diminution 
of the influence of the brain upon the heart. The inequality 
and intermission of pulse, which may be compared to the con- 
vulsive state of the muscles, does not at all prove the existence 
of astheny, or we must attribute to debility every crisis which is 
announced by intermission and inequality of the pulse. The case 
in which the pulse is not altered in ataxy, only shows that the 
heart may remain unaffected in the midst of the disturbance oc- 
casioned by the cerebral irritation. May it not be asserted, that 
if astheny of the heart sometimes occurs in ataxic fever, it is ge- 
nerally only apparent, and most frequently the symptom of an 
irritation. 

The alternation of paleness and redness of the face, as it does 
not correspond to the change of the pulse, must be considered as 
an effect of the cerebral influence on the capillary circulation of 
the skin. 

There is nothing in the variations of the temperature of the 
skin, which particularly characterizes ataxic fever; we find it 
augmented in one part and diminished in another, in every case 
of intense inflammatory, or hemorrhagic congestion, which is 
evidently active. If, for example, the skin covering the abdo- 
men is burning, while that of the feet is very cold, this diffe- 



248 PHYSIOLOGICAL PYRETOLOGY. 

rence announces an irritation of one of the abdominal viscera 
in ataxic fever, as well as in every other disease in which the 
symptom occurs. Shall it be said that coryza and epistaxis are 
owing to weakness or ataxy, because they are often preceded or 
accompanied, sometimes by a general rigor, at other times by a 
remarkable coldness of the hands and feet? 

I think it unnecessary to proceed farther in this examination 
of the symptoms of ataxic fevers, for it is in vain that a sign of 
weakness is sought in the state of the respiration, the secretions, 
and excretions: moreover, I treated of certain peculiarities of 
these functions, when on the subject of adynamic fever. Thus 
far we have seen that the phenomena of ataxic fever for the most 
part announce irritation, and that a very limited number of them 
indicate weakness, which even in these cases may be contested, 
or it may be only functional or local. What is there then to 
lead to the supposition that this fever is owing to ataxy; a pecu- 
liar modification of the vital action, differing from weakness and 
irritation, since it is announced by the symptoms of these two 
states divided in such a manner that the phenomena of irritation 
predominate? 

What has caused this disease to be attributed to a disorder, de- 
rangement or perversion of the vital action is the apparent inco- 
herence of the symptoms, and the disorder existing in the rela- 
tions which are established between the different functions in 
general, and between the different parts of the same system or 
apparatus of organs in particular? 

Do the incoherence of the symptoms announce a domination 
of that sympathetic connexion of the organs which is so necessa- 
ry to the maintenance of life? No ! This apparent disorder proves 
the contrary; when in the latter stages of the ataxic fevers, the 
union of the organs becomes less intimate and the symptoms 
which manifest themselves, are those of prostration, there is no 
longer incoherence; that is to say, symptoms of irritation on one 
point, and those of weakness on another? Now, if from our 
knowledge of adynamic fever, it be not rational always to attri- 
bute the symptoms of prostration to astheny, it would be much 
less so to attribute them to a pretended ataxy, which the disor- 
der of the symptoms does not indicate. Let us now examine 
this pretended disorder. 

Selle gives, as the principal characteristic of ataxic fever, ner- 



ATAXIC FEVER. 249 

Vous symptoms without any relation between them, and not cor- 
responding to manifest causes. It would be easy to prove that 
these symptoms answer perfectly to their causes, although we 
cannot explain how the latter produce them, except by pointing 
out the organs upon which they act, the symptoms which they 
determine in those organs, and the morbid traces left after death. 
Selle, less vague than Pinel, attempts to describe this disorder 
of the symptoms: a certain sensation of disease without appa- 
rent symptoms; (this is only the malaise which precedes all 
diseases;) no complaint or despondency ivhen the symptoms are 
of an alarming character. (How is the patient to judge of the 
danger of symptoms? Are phthisical patients who die in the 
midst of schemes of pleasure in a state oiLataxy?) the fear of 
death; it should at least be added, when the disease appears of 
little intensity; this despondency is peculiar to some indivi- 
duals who are alarmed by the slightest morbid state, and it is par- 
ticularly observed during the prevalence of fatal epidemics: in- 
somjwhnce without fever or pain; this is one of the precursory 
signs of all diseases; there is here no incoherency; pain must not 
necessarily exist to keep the brain awake, since excessive heat 
is sufficient to determine insomnolence; pulse more weak and 
concentrated at the time of the accession and exacerbations, 
(this only shows that the congestion which occurs in ataxic fever 
is more serious than in any other,) tongue dry without thirst, 
or moist with great thirst; when there is lesion of the brain, it 
ceases to perceive, that is, during a state of suffering, like all 
other organs it ceases to act; in health the thirst is often exces- 
sive without the tongue ceasing to be moist; in chronic inflam- 
mations of the pharynx, which accompany chronic inflamma- 
tions of the stomach, there is no thirst although the tongue and 
throat are dry, and yet no one sees ataxy in this case; the skin 
dry without heat; what more common than this symptom? Sweat 
not salutary; is the sweat, then, salutary in all except ataxic 
fevers? Spontaneous passage of worms. No one, since Selle, 
has given this symptom as a sign of ataxy; excretions without 
any improvement in the symptoms; this takes place in all 
diseases while they are not on the decline. Finally, must 
we add to this series of unimportant symptoms the following, 
to which Selle did not attach less importance than to the 
others? Blood-letting does not assuage the pain; it is followed 

32 



25Q PHYSIOLOGICAL PYRETOLOGY. 

by hiccough; emetics do not produce vomiting, but they readily 
purge. 

Without spending more time in this refutation, which proves 
on what slender grounds celebrated men have been pleased to 
create orders and genera of diseases, I proceed with a view to 
the juster appreciation of the pretended disorder which is said 
to prevail in ataxic fever, to sketch the principal shades of these 
diseases, instead of confining myself to the narrow circle of a 
description too general to be true, or of an incoherent list of 
symptoms. 

When the invasion of these fevers is not sudden, it is an- 
nounced sometimes by derangement in the cerebral action, 
sometimes by the signs of a lesion of the digestive organs, and 
finally, sometimes by signs of reaction in the circulatory system, 
or of plethora. In the first case they are preceded by cephalal- 
gia, heaviness of the head, somnolence, vertigo, moroseness, in- 
quietude and distress without apparent cause, sad presentiments, 
agitation, spontaneous lassitude, or syncope. In the second case 
we observe the premonitory symptoms of gastric, bilious or mu- 
cous fevers. In the third case all the precursory phenomena of 
inflammatory fever are observed. It thus appears that ataxic 
fever may commence in many different manners. 

1st. When, after all the phenomena of excited circulation 
which have been enumerated, when treating of inflammatory fe- 
ver, the irritation which constitutes this fever becomes more 
easily recognised, on account of its progress, if it be seated in the 
brain or its *nembranes, or if these parts are deeply influenced 
by the irritation which constitutes the disease, sensibility is ex- 
alted, the eye becomes more sensible to the light, the ear to 
noise, the conjunctiva is injected, pains are felt in the bottom of 
the orbit, in the forehead or occiput, or the headache increases 
very much; there is dimness of vision and vertigo; the sense of 
smell is blunted or revolts at the slightest odour, there su- 
pervenes wandering of the mind, delirium, somnolence, insom- 
nolence or painful dreams, and interrupted sleep, the body falls 
into a torpid state, and becomes painful in some points. Here, 
it is evident that irritation has increased in the cerebral appara- 
tus, or that it has extended to it? These new symptoms have 
the greatest analogy to those of cerebral congestion without in- 
flammatory fever, or rather they are the same. Why, then> 



ATAXIC FEVER. 251 

should the nature of the lesion producing them not be recognised, 
when they appear after other symptoms, whilst there is not 
the slightest doubt concerning them, when they manifest them- 
selves primitively? Who can nfhrk with accuracy the instant 
when an inflammatory fever, owing to cerebral irritation, be- 
comes an ataxic inflammatory fever? It is evident that there 
is merely an increased intensity of the symptoms, which only 
supposes an analogous increase of irritation in the organ in which 
they manifest themselves. In the inflammatory fever, owing to 
gastric, uterine, or any other irritation, the cerebral symptoms, 
which I have described, instead of increasing, generally make 
their appearance after those of the primitive irritation, upon 
which, sympathetic irritation of the brain supervenes: from this 
period, the latter affection, if it do not engross, should at least 
share the attention of the physician. 

2. After the continuance for several days of the gastric or in- 
testinal embarrassment, which is only an irritation of the stomach 
or intestines with or without bilious or mucous secretion, the 
headache, hitherto supportable, becomes exasperated, the sensibi- 
lity of the organs of sense is augmented, and delirium or som- 
nolence supervenes. Is it not evident, in this case, that the disease 
which hitherto had exercised but a feeble influence over the en- 
cephalon, has invaded this organ or its connexions, in a high de- 
gree, and that there is not a complication of two diseases of a dif- 
ferent nature, but an extension of the seat of one disease? Con- 
sequently, the terms gastro-ataxic and mucoso-ataxic fever, can 
only create erroneous ideas, by giving rise to the opinion that 
we behold two opposite morbid conditions, contending with each 
other, and which it is necessary to reconcile, or to attack in suc- 
cession. 

3. After the slight cerebral symptoms, which have been men- 
tioned, have continued for a longer or shorter time, the cephalalgy 
becomes excessive, somnolence is succeeded by a profound coma, 
the inquietude by a sort of despair, agitation by convulsive move- 
ments, vertigo by dilirium, spontaneous lassitude by depression, 
complete prostration, or even partial or general paralysis. No- 
thing, in this case, authorizes the opinion that the disease has 
changed its nature, since each of the symptoms has only in- 
creased, and if others supervene, having the nervous system for 
their seat, they cannot be attributed to any other lesion than that 



252 PHYSIOLOGICAL PYRETOLOGY. 

which gave rise to the symptoms which hare been mentioned, or 
they are the effect of a modification of structure determined in the 
cerebral apparatus by this same lesion. The present case is 
one in which the ataxic feve» is said to be simple, because the 
circulation is but little deranged, and the symptoms of gastric 
derangement are not important, or they may even be wanting. 
It is called cerebral fever when the disease attains such a degree 
of intensity as to give rise to the most violent symptoms of irri- 
tation of the brain or rather of arachnitis. It was to justify the 
admission of this sort of local fever among ataxic fevers, the ex- 
tension of which to the whole organism was not questioned, that 
the following sentence was subjoined to the description of ataxic 
fever ; viz. " These lesions are nearly equal in alLthe organs, or 
they may be stronger in some: hence cerebral fevers, &c." Here 
we observe Pinel advanced a step towards the localization of 
fever, but he suddenly stopped. A profound study of the works 
of Bordeu would have hastened rather than have suspended his 
progress. 

Sometimes the symptoms of cerebral excitement or oppression 
suddenly make their appearance during the soundest health. It 
being admitted that these are the only symptoms, why should any 
thing be seen in this affection but what is annonnced by the phe- 
nomena, that is, an irritation or an astheny? post mortem appear- 
ances might then be consulted to determine whether the affection 
of the brain be of the character we suppose. This has not been 
done in this variety of simple ataxic fever; S3'mptoms of excite- 
ment and of debility have been found united, and from this cir- 
cumstance they have been considered as owing neither to de- 
bility nor to excitement^ and, to account for their development, 
the word ataxy has been used, which signifies absolutely no- 
thing. When death occurs rapidly in ataxic fever supervening 
suddenly, the morbid cause has generally spent its whole force 
upon the encephalon, although it might primarily have acted 
upon the digestive apparatus, or upon the lungs. When we find 
morbid traces after death, which is always the case, they are 
observed in the encephalic apparatus. 

5. The ataxic symptoms supervene frequently in the midst 
of those of a manifest inflammation of the lungs, the stomach, 
the uterus, or the liver; perhaps most frequently during the most 
intense degrees of these phlegmasia. Since after death we gene- 



ATAXIC FEVER. 253 

rally find traces of inflammation in the cncephalon as well as in 
one or more of the organs just mentioned, what can authorize 
the opinion that the ataxic phenomena arc the effect of some oc- 
cult cause, sui generis? Why have these phlegmasia* been re- 
garded as peculiar in their nature? as ataxic inflammations? How 
does a phlegmasia change its nature by extending to many or- 
gans? 

6. The greatest variety prevails in the progress and develop- 
ment of the symptoms of ataxic fever. Sometimes the inflam- 
matory, gastric, bilious, or mucous symptoms continue notwith- 
standing the appearance of the nervous symptoms; sometimes 
they disappear entirely, or nearly so. To these symptoms of 
excitement are often joined those of prostration, without, how- 
ever, a cessation of the former. Thus, although prostration 
supervenes, the eyes become excessively sensible to the light, 
and the delirium continues; convulsive movements continue in 
the limbs, which at last fall into paralysis. In other cases, pros- 
tration first occurs, and is followed by excitement; there is af- 
terwards a mixture of the symptoms of both states. The scene 
is terminated sometimes by terrible convulsions, and sometimes 
by a profound prostration. Occasionally, though rarely, the cere- 
bral symptoms cease, in some cases almost suddenly, though more 
frequently by degrees: there only remain the inflammatory 
gastric, bilious or mucous symptoms, which diminish or cease; 
or these symptoms themselves may disappear in the first place, 
and the disease proceed more or less rapidly towards a cure. 

7. The duration of these fevers is said to be from one day to 
two, three, four or even more weeks. Sometimes the patient 
continues to present some cerebral symptoms, generally con- 
joined with those of mucous fever, and continues in this state 
for thirty or forty days, or more: he appears to be only slight- 
ly affected, but the ataxic symptoms augment, predominate over 
all the others, and, notwithstanding partial evacuations, he gene- 
rally succumbs. This is the affection which Huxam denominated 
sloiv nervous fever: it is the mucous ataxic fever of Pinel. 
At other times, transient cerebral symptoms succeed each other 
slowly, in a subject who presents no mucous symptom, and he 
often perishes, as in the preceding case. This is the nervous hectic 
fever of Willis, which is only observed in old men after encepha- 
lic hemorrhage, arachnitis or encephalitis. 



254 PHYSIOLOGICAL PYRETOLOGY. 

8. Among the symptoms of inflammatory, gastric, or mucous 
fevers, the symptoms of adynamy conjoined with those of ataxy 
are sometimes observed to supervene, that is to say, they are ac- 
companied with sordes of the teeth, a black coating of the tongue, 
fetid diarrhoea, fetid and partial sweats, &c. This state constitutes 
the gastro-adynamo-ataxic, mucoso-adynamo-ataxic, or ataxo-ady- 
namic complications, which are only gastro-cephalites with or 
without inflammation of another organ than those of the cerebral 
or digestive apparatus. 

The termination of ataxic feVers, w'hen abandoned to nature, 
is generally fatal, evacuations seldom announce a cure; when the 
termination is favourable, we often observe an inflammation of 
the parotids, an abscess in the cellular tissue of the limbs or 
about the region of the lymphatic glands. The patient, escap- 
ing death, often remains blind, deaf, paralytic, in a state of stu- 
por, of stupidity, or without memory, at least during a certain 
time, and sometimes for ever. Under these circumstances, he 
generally dies in a few months or years, unless he be very young. 
In gastro-ataxic fever evacuations very seldom announce a re- 
covery; indeed, not less seldom in this fever than in the others 
which are discussed in this chapter. 

Hippocrates endeavoured to point out the phenomena which, 
in acute diseases, announce the approach of death: most of these 
symptoms have been ranked among those of ataxy; and it is with 
truth, that M. Broussais has said, that nosologists have sought 
the signs of ataxic fever in the last agony. However this may 
be, the following are the signs, none of which have any value, 
except in conjunction with several others; viz: A profound coma, 
from which nothing can arouse the patient, obstinate insomno- 
lence, unequal dilatation of the two pupils, immobility of the 
pupils, a convulsive rolling of the globe of the eye, which has 
lost its brilliancy; aphonia, embarrassed deglutition, noise made 
by fluids falling into the oesophagus, irregularity of respiration 
which is interrupted, obstinate hiccough; carphology, subsultus 
tendinum, convulsions, pulse calm, in the midst of the most 
alarming symptoms; meteorism of the abdomen, a very abun- 
dant diarrhoea, an escape of fecal matter without the knowledge 
of the patient, a cold, clammy, and partial sweat; finally, he- 
morrhagies, which nothing can arrest, particularly those in which 
the blood is black, and coagulates but imperfectly. It is proper 



ATAXIC FEVER. 255 

to repeat, that none of these symptoms announces death when 
they appear alone. But when there is a concurrence of many 
of them, there is great reason for apprehension. It is far from 
being the fact, that these phenomena always precede death; it 
often occurs without the slightest warning, but what is derived 
from the intensity of the symptoms, or the known character of 
the prevailing epidemic. 

Since, in forming the class of ataxic fevers, nosologists havo 
collected and compared the cases in which the nervous, and par- 
ticularly the cerebral symptoms predominate over all others, the 
brain should be examined in preference to other parts, in ex- 
ploring the seat of the disease: it is natural to seek it here, and, 
at first, the idea of it existing in the other viscera was not enter- 
tained. Most of the physicians who have prosecuted researches 
of this nature, generally agree, that dissection discovers traces of 
lesions of the brain, and its membranes. At the same time that 
they pointed out the lesions of the eneephalon, in malignant or 
ataxic fever, some of these authors have not neglected to note 
the alterations which were observed in the other viscera, but 
most of them considered the latter as the effects of the fever. M. 
Prost appears to have been the first who positively affirmed that 
ataxic fevers result from an inflammation of the mucous membrane 
of the intestines. " I have made," said he, u more than two hun^ 
dred examinations of persons who had fallen victims to ataxic 
fever, and I have always observed inflammation of this mem- 
brane."* 

If we read with care, the different collections of observations 
in pathological anatomy, published from the time of Bonnet, to 
the present day, we shall find scattered through them a multi- 
tude of cases, in which death having occurred after malignant 
or ataxic symptoms, dissection has discovered traces of inflam- 
mation, or irritation in other parts, besides the brain and diges- 
tive viscera. Morgagni relates a considerable number of such 
cases. These post mortem appearances, are calculi in the sub-, 
stance of the kidney, in the pelvis, in the uterus or bladder, or 
inflammation, and suppuration of these organs; inflammation 
of the peritoneum or uterus, abscesses in the liver; vomicae in 
the lungs, the existence of which had not been suspected; he- 

* Medicine Eclairie par V Observation ct V Overture des corps, Introduc- 
tion, p. 56. 



256 PHYSIOLOGICAL PYRETOLOGY. 

patization of this viscus; pleurisy and pericarditis, where no- 
thing had indicated these affections; in a word, there is no part 
of the body in which an active inflammation, or a violent irrita- 
tion, suddenly or gradually developed, has not occasioned death, 
after having determined ataxic symptoms. The traces of this 
inflammation, when seated in the abdomen or chest, are often 
accompanied with an effusion of serosity into the cranium: at 
other times, nothing is found in this cavity. 

There are cases of ataxic fever, which leave traces of no le- 
sion, either in the brain, the organs of digestion, or in any other 
part of the body. These cases are the least numerous, they are 
not so few in number as the cases of adynamic fever, without 
traces of gastro-enteritis, although they are less common than is 
generally thought. 

We shall now attempt to establish the comparative frequency 
of the numerous organic alterations, observed after ataxic fever. 
Should I form a judgment from the works of physicians who 
have investigated with care the seat of these fevers, and from 
my own observations, in the greater number of cases, there are 
found traces of inflammation of the meninges, or of the brain: 
these are generally accompanied by marks of inflammation in 
the digestive canal; then follow the less numerous cases, in 
which the canal alone is altered in its structure; afterwards, those, 
less numerous still, in which the encephalon alone is altered: 
finally, the more common case, in which inflammation of some 
other organ than those of digestion, has determined death by 
exciting the brain, whether the latter has or has not undergone 
a true sympathetic inflammation, and whether it does or does 
not present morbid traces. The least common cases, are those 
in which no traces are found after death. 

The lesions found in the cranium after ataxic fever, are, ful- 
ness of the vessels of the meninges, of those of the brain, or of 
both; redness and opacity of the arachnoid; redness of the ce- 
rebral substances; serous or gelatinous effusions, generally in the 
ventricles, on the hemispheres, or at the base of the cranium; 
sanguine effusions in the cerebral substances, sometimes on the 
surface of the arachnoid, purulent effusions, false membranes on 
the surface of the arachnoid, pus infiltrated between the arach- 
noid and pia mater or in the cerebral substance, collected in small 
masses; or an abscess in this substance, with or without sanguine 
infiltration. 



ATAXIC FEVER. 257 

Too little importance has been attached to these different le- 
sions: however slight some among them appear to be, they must 
not be disregarded in an investigation of the nature and seat of 
the disease, after which they are observed. If they are found 
in a great number of bodies, it is because death rarely occurs 
without the previous existence of some ataxic, that is, cerebral 
symptoms, for the brain must always be affected before death oc- 
curs. To judge with accuracy of the part which encephalic ir- 
ritation performs in ataxic fever, we must consider the nature of 
the lesion, the period at which the ataxic symptoms manifested 
themselves, and the degree of intensity, as well as the number 
of these symptoms. There are yet many researches to be made 
before we can determine with accuracy during life, the state of 
the encephalon; but whatever difficulties embarrass the subject, 
it is our duty to prosecute it with ardour. The works of MM. 
Coutanceau,* Ducrot,t Deslandes,:}; Parent and Martinet, but es- 
pecially those of Professor F. Lallemand, have produced results 
too advantageous, not to inspire physicians with a desire to fol- 
low their example. It can already be affirmed, that the altera- 
tions presented by the brain and its membranes are always owing 
to a greater or less degree of inflammation. This has been es- 
tablished beyond a doubt by M. Lallemand. 

We have in the preceding chapter mentioned the alterations 
discovered in the encephalon by M. Andral at the termination 
of thirty-eight grave fevers. M. Louis remarks, that in two of 
the subjects opened by him, after what he calls the typhoid af- 
fection, the arachnoid was attached over a considerable space to 
the superior part of the brain, by a false membrane, which was 
extremely soft; the cortical substance was more or less rosy or 
red in seventeen subjects, the medullary substance injected in 
most cases, generally in a moderate manner; both these sub- 
stances were slightly softened in seven subjects: there was in 
two others a partial softening, inconsiderable in extent, confined 
to the septum lucidum, or one of the thalami nervorum optico- 

* Des Epanehments dans le crane, pendant le cours des Fievres Essen- 
tielles, Paris, 1802, in 8vo. 

f Essai sur la Cephalite, Paris, 1812, in 4to. 

X Examen des Differentes formes que peut prendre la Phlegmasie des Me- 
ninges, Paris, 1817, in 4to. 

33 



258 PHYSIOLOGICAL PYRETOLOGY. 

rum; the cerebellum presented the same alterations as the brain in 
a smaller number of cases. 

We must here remember, that M. Louis classes convulsive 
movements among the symptoms of what he calls the typhoid 
affection; which affection he wishes to refer solely to a lesion of 
the glandular Peyeri. 

Now we perceive, that in most of the cases, the encephalon 
was not in its normal condition, and we know not how he could 
so ligthly regard alterations, the importance of which he cannot 
but be aware of at the present day. We repeat it, the correctness 
of his descriptions is continually refuting his theory. 

The spinal marrow often participates in the state of the brain; 
probably there are cases in which it is more affected than the 
latter, but its alterations are but yet little known. They form 
an interesting subject of research, and cannot fail to throw much 
light upon the theory of fevers. Attention was first drawn to 
this subject by J. P. Frank. 

Before him, Hoffman had spoken of the part performed by 
the spinal marrow in fevers. The venerable Chaussier has some- 
times found traces of inflammation on the surface of this part of 
the nervous system, in subjects who had fallen victims to ady- 
namic fever. Abercrombie, Brera and Rachetti, have made ana- 
logous observations; the first after malignant, and the last after 
petechial fevers. M. Ollivier has frequently observed a consi- 
derable injection of the vessels, covering the pia mater of the 
spinal marrow, in subjects who had presented all the general 
symptoms of adynamic fever. How much research remains to 
be made on this point of pathological anatomy and physiology! 

The alterations found in the digestive system after ataxic fever 
do not differ sensibly from those found in the same apparatus af- 
ter adynamic fever. There are striae and patches of a more or 
less deep red, or black patches more or less extended, ulcers, the 
extent, number, form and depth of which vary infinitely, with- 
out our being able to establish any relation between these varie- 
ties and those presented by the cerebral symptoms. This need 
not excite surprise, for danger is the more urgent in proportion 
as the encephalon is more irritable, and it is not repugnant to any 
known principle to admit that a feeble gastric irritation some- 
times determines a violent cerebral irritation, since a small quan- 
tity of wine, any disagreeable news of however trifling a cha- 



ATAXIC FEVER. 259 

ractcr, or the slightest pain is sufficient to disorder the intellects 
•of some persons. 

If the various alterations of the digestive canal, have but lit- 
tle relation to the cerebral phenomena, they correspond perfect- 
ly to the gastric symptoms which have preceded or accompanied 
these phenomena. The remarks made in the preceding chapters, 
with regard to this relation, are perfectly applicable here. 

When the gastric symptoms have ceased on the appearance of 
the cerebral phenomena, we often find in the digestive canal, 
traces of the inflammation which occasioned these symptoms, 
but sometimes no traces are discoverable, whether it be the case, 
that the gastro-enteritis has really ceased, which occurs only un- 
der the anti-phlogistic treatment, or that it has continued in too 
slight a degree to have traces after death. 

When the encephalic irritation, or inflammation has been pro- 
voked by croup, bronchitis, pleurisy, pneumonia, pericarditis, 
hepatitis, cystitis, in a word, by any other inflammation than 
that of the stomach and intestines, when death has been the re- 
sult of an inflammation which has been recognised, but has been 
considered ataxic, or complicated, with a pretended ataxic fever, 
no other traces are found in the organ primitively inflamed, than 
those observed when death has not been preceded by this com- 
plex series of ataxic symptoms. Sometimes no vestige of in- 
flammation is found, it having ceased at an early period, or its 
traces having disappeared with the cessation of the circulatory 
movement. Thus, the case is the same here as in ataxic fever, 
occasioned by the influence of a gastro-enteritis upon the brain, 
and, as in that case, morbid traces are sometimes found in the 
encephalon, and sometimes not. The latter organ has seldom 
time to become deeply affected, because death occurs more ra- 
pidly, owing to the affection of the two important viscera: thus, 
we rarely find lesion of the brain after ataxic peripneumony, and 
this has occasioned a mistake, with regard to the part performed 
by the encephalon in ataxic fevers, complicated with manifest 
inflammation of the pectoral viscera. The same observation ap- 
plies to the cases in which the abdominal viscera being mani- 
festly inflamed, death supervenes rapidly. 

It results, from what has been said, that ataxic fever is only 
an inflammation, or an irritation of the brain, and some other or- 
gan, that the cerebral irritation is generally secondary, that it 



260 PHYSIOLOGICAL PYRETOLOGY. 

generally depends upon gastro-enteritis, but that any other in- 
flammation may occasion it; that the primitive phlegmasia of the 
digestive canal, or of any other organs may cease and leave no 
trace, that of the encephalon continuing till death, and that the 
traces of the latter may disappear before the opening of the body: 
this explains the cases in which no vestige of inflammation is 
found. 

It remains to demonstrate that there are ataxic fevers, solely 
derived from a primitive irritation, or inflammation of the brain 
and its membranes. Nothing shows that this cannot be the 
case; we are, however, to remember that these are the most un- 
frequent cases. But the diagnosis of these fevers is often most 
difficult: in the first place, because there is often gastro-enteritis 
in ataxic fevers, the most simple in appearance, that is to say, 
in those which present no bilious or mucous symptom at any 
period of their course; in the second place, the primitive cere- 
bral irritation often gives rise to a sympathetic irritation of the 
stomach and intestines. This transmission of the irritation of 
the brain and its membranes, is not constant, whatever may be 
said by M. Broussais.* But when it occurs, it occasions the 
greatest embarrassment. When we are called to a patient pre- 
senting all the phenomena of ataxy, with symptoms of gastro- 
intestinal irritation, it is rarely possible to know whether the 
brain suffers primitively or secondarily. We, however, should 
remember that dissection renders it most probable that its le- 
sion is secondary. 

When to the cerebral phenomena, are joined the symptoms of 
some other inflammation than gastro-enteritis, there is the same 
difficulty to decide whether the irritation of the encephalon is 
primitive; but a farther difficulty presents itself, to determine 
whether there is not, also, a latent inflammation of the diges- 
tive passages. 

Those among my medical brethren, who can see only subtle- 
ties in these questions, do not perceive that their solution would 
entirely dissipate the obscurity which still rests upon the seat of 
ataxic fever, would put an end to the uncertainty which harasses 
us at the bed-side of the patient, and would furnish a certain ba- 
sis for the diagnosis, as well as the treatment of these fevers, 
which have hitherto defied, and still defy the powers of medicine. 

* Deuxieme Examen. 1, p. 29, prop, cxviii. 



ATAXIC FEVER. 261 

When \vc shall perfectly understand the part performed by- 
each organ in ataxic fever, and especially by the brain and its 
connexions, we shall no longer have an inextricable labyrinth of 
functional derangements; we shall then be able to direct our at- 
tention methodically and profitably to the means proper to arrest 
the progress of the disease. Until then, notwithstanding the 
satisfactory progress already made in pathology, we shall still be 
reduced to the adoption of tentative means in a diversity of in- 
stances. 

The study of the causes of ataxic fever, remedies in part the 
difficulties presented by the investigation of the primitive irri- 
tation, and the appreciation of the state of the digestive pas- 
sages in these diseases. 

Ataxic fevers have no other causes than those of inflammatory, 
gastric, or adynamic fevers: yet it is necessary to their occur- 
rence, that the subject be naturally predisposed to encephalic ir- 
ritations, or that he should have been exposed to the causes most 
capable of irritating the brain. It is on this account that ataxic 
fever occurs more frequently in infants and women, than in 
males and old persons; in those who are called nervous, that is 
to say, who feel acutely, whose sensations and volitions are vio- 
lent and impetuous, and succeed each other with rapidity ; in 
those who have been a long time exposed with the head bare to 
the rays of the sun, who have received blows upon the head, or 
have fallen upon any part of it, who are addicted to intense stu- 
dy, a prey to grief, or who have injured themselves hy exces- 
sive venery; finally, in those who have sustained a great loss of 
nutrient materials by abundant evacuations of mucus, pus, or 
blood, or who have been exposed to the influence of deleterious 
emanations, of putrid food, the action of which is rapidly pro- 
pagated to the brain. 

When the patient has been exposed only to causes capable of 
acting directly on the encephalon, such as lesions of the cranium, 
or brain itself, or of its membranes, by a mechanical cause, by 
too violent sensations, impetuous passions,or excessive venery, and 
the cerebral symptoms manifest themselves alone, there is rea- 
son to believe that the gastric passages are not affected, especial- 
ly if hitherto they have given no sign of irritation. When they 
have not been irritated before the invasion of the disease, and 
they afterwards appear to become so, there is reason to believe 



262 PHYSIOLOGICAL PYRETOLOGY. 

that their irritation is sympathetic, and depends upon that of the 
brain. 

If, on the contrary, the person has been drinking and eating 
to excess, or using putrid food, if he has been exposed to the 
influence of deleterious emanations, if there be any signs, how- 
ever inconsiderable, of gastric irritation, we may presume that 
the digestive organs are the principal seat of the irritation: we 
may even presume this to be the case, when there is no symp- 
tom of gastro-enteritis; for it often happens that the morbid 
state of the brain prevents the development of the sympathetic 
effects, which might announce gastro-enteritis, w T hile the latter 
continues its ravages, or may even become aggravated, if it be 
misunderstood, or treated improperly. 

Finally, if to the causes capable of disposing the encephalon 
to become irritated, are joined the causes of the irritation of any 
other organ, as the lungs, or the uterus, we must not neglect to 
investigate the influence which they may exert, at the same time, 
or secondarily, upon the organs of digestion. 

In acting upon the encephalon, or upon the gastro-intestinal 
mucous membrane, at the same time or successively, the causes 
of ataxic fever may extend their influence to the gall-bladder, 
or the biliary ducts, to the liver, the kidneys, the uterus, or the 
bladder. We easily recognise during life, these different irrita- 
tions by the icterus, and the suspension or suppression of urine. 
After death, we often discover traces of these irritations, and if 
I have not yet spoken of them, it is because, they are almost al- 
ways secondary in essential ataxic fever, although a primitive 
inflammation of the biliary and urinary apparatus may, like gas- 
tro-enteritis, determine a secondary encephalitis, and the ataxic 
symptoms which result from it, as is shown by the terrible con- 
sequences of traumatic cystitis, or hepatitis. 

We thus see that if the ataxic fever approaches the adynamic 
fever in respect to its origin, it differs from it in this; that it may 
be the effect of causes which act only on the brain, and that these 
same causes almost always contribute to its production, even when 
they do not produce it alone; that, consequently, the ataxic fever is 
often the effect of a primitive cerebral affection, a state which is 
incontestably an irritation, and which the physician should never 
neglect. We perceive that if ataxic fever is, like adynamic 
fever, most frequently only the last scene or highest degree 






ATAXIC FEVER. 263 

of inflammatory, gastric, or mucous fevers, it is in this case 
owing to a complication which requires means appropriate to 
the sympathetic irritation of the brain. It is not, under these 
circumstances, always sufficient to direct our measures against the 
primitive irritation of the stomach, the intestines, or any other 
organ, to cure the lesion of the encephalon and dissipate the 
ataxic symptoms dependent upon it. 

In his first work, M. Broussais appeared to attribute ataxic fever 
solely to gastro-enteritis; the symptoms peculiar to those fevers 
did not depend entirely, according to him, upon the influence of 
the stomach and intestine upon the brain. He now acknowledges 
that the latter organ may become inflamed under the influence 
of gastro-enteritis, and that we have then to contend with two 
dangerous inflammations; yet, when he attempts to define ataxic 
fever, he contents himself with saying that it is a gastro-enteritis 
with considerable irritation or phlegmasia of the brain.* If this 
definition be more complete than that of M. Prost, which M. 
Broussais formerly opposed,t it is objectionable in assigning too 
much importance to the gastric inflammation, and not sufficient 
to the cerebral, which is always regarded as secondary. 

There are ataxic fevers without gastro-enteritis; but there are 
none without encephalic irritation: on this account I think the 
definition of M. Broussais is erroneous: it should be as follows; 
ataxic fever is an encephalitis, sometimes primitive, more fre- 
quently secondary, generally accompanied with gastro-enteritis 
or supervening in the course of inflammation of the lung, the 
uterus, the peritoneum, &c. 



Treatment of Ataxic Fever. 

How surprising is the absurdity of those physicians, who, at- 
tributing ataxic fever to a profound lesion of the nervous system, 
to a sort of obstruction and compression of the origin of the 
nerves, to a disturbance, or subversion of the general laws of the 
animal economy, can devise no fitter remedial measure, than 
the exhibition of an emetic, followed by the immediate employ- 

* Deuxiime Examen, p. 34, prop, exxxviii. 
t Hist, des Phleg. Chron., 2d edit. 2, p. 7. 



264 PHYSIOLOGICAL PYRETOLOGY. 

ment of tonics; who advise to sustain the strength by incessant 
doses of generous wine, and to remedy the general debility by 
the employment of stimulants, and who reject blood-letting al- 
together, whatever may be the symptoms of inflammation, under 
the vain pretext that all the causes of ataxic fever are debili- 
tating, although they admit a state of effervescence of the head, 
and assert, that after death " we most frequently find serous effu- 
sion into the lateral sinuses, sometimes all the characters of an in- 
flammatory state of the meninges, which have become opaque 
and thickened," and although they declare that " the momentary 
excitement resulting from the employment of the most active 
stimulants, is soon succeeded by a state of debility still more 
dangerous."* 

It is evident that if these physicians have suspected the part 
performed by the brain in the production of ataxic fever, and 
perhaps even the nature of the lesion which exists in this organ, 
they have fallen into the most dangerous contradiction in re- 
commending the employment of all the means most calculated 
to increase the encephalic irritation. It is not less evident that 
they have entirely misunderstood the gastro-enteritis, which is so 
often the primary focus of the ataxic symptoms, and which exists 
often when the encephalitis is primitive. If several physicians 
have demonstrated the inflammation of the brain in the fevers of 
which we are speaking, we owe to M. Broussais the knowledge 
of the frequency of gastro-enteritis in these diseases: he has con- 
verted into certainty the suspicions of those among his predeces- 
sors and contemporaries who indistinctly saw irritation of the 
digestive apparatus in malignant fevers, without completely re- 
nouncing the employment of stimulants. We are indebted to 
him for proving the necessity of banishing stimulants from the 
treatment of these fevers, and the result has been a decrease of 
the mortality. 

To combat the tendency observed in some individuals to cere- 
bral irritations; to remove the causes which may strengthen or give 
rise to this disposition, and those, which, acting directly on the 
encephalon, on the digestive passages, or any other part of the 
body, may primitively or secondarily occasion irritation or inflam- 
mation of the brain and its meninges, to attack with energy the 

* Nos. Phil. p. 263, 264, 268, 276, &c. 



ATAXIC FEVER. 265 

irritations which might, by becoming aggravated, determine that 
of the encephalon, finally, to combat the latter from the moment 
of the appearance of the slightest symptoms; such is the course 
we must pursue with a view of preventing or retarding the de- 
velopment of ataxic fevers. 

To cure them, which is very difficult, we must combat the 
irritation of the encephalon by drawing blood from the head and 
lower extremities; by the application of ice to the former, plung- 
ing the latter into a hot bath, and by giving warm or cold drinks. 
If the stomach be inflamed, we must apply leeches to the epi- 
gastrium, and emollient or refrigerant fomentations to the ab- 
domen; if there be diarrhoea, leeches must be applied to the anus 
and emollient and anodyne lavements must be administered; if 
there be pain in any point of the abdomen, leeches must likewise 
be applied; they must be placed below the false ribs on the right 
side, if the region of the liver be painful and the conjunctiva and 
skin yellow; to the hypogastrium, if the uterus be painful, to the 
loins or perineum if the urine be suppressed. At the same time 
we should adopt the measures I have pointed out against ence- 
phalic irritation. 

In every case, diffusible stimulants, blisters and all excitants 
which might occasion acute pain should be • discarded: these 
measures only procure transient advantage, by irritating the 
brain; this irritation cannot but be injurious, since it affects an 
organ already irritated. We may employ cups, sinapisms and 
rubefacients, taking care not to excite too much pain: it is suffi- 
cient to redden the skin, for the objects we propose; that is, to 
produce revulsion when it is possible. 

If the disease be prolonged and the digestive passages are not 
irritated, we may administer veal water or chicken water, which 
we may discontinue, provided the cerebral symptoms increase, 
or those of gastritis manifest themselves. 

Such is the only method which we can generally follow in 
ataxic fevers; if it be not always crowned with success, it is at 
least appropriate to the nature and seat of the disease; it is also 
that which most frequently succeeds; it is never injurious when 
we do not carry blood-letting too far. There are some cases in 
which we should take blood copiously, others in which we 
should be reserved in the employment of this measure, and, 
finally, others in which we must entirely abstain from it, unless 

34 



266 PHYSIOLOGICAL PYRETOLOGY. 

the disease be very intense; for in this case, if we omit Blood- 
letting, and the patient die, we shall have reason to reproach 
ourselves with the neglect of a remedy so often efficacious. 

In plethoric and vigorous subjects, whose circulation is ener- 
getic, as well as in those who present the marks of the bilious 
temperament, we should bleed copiously from the foot, from the 
jugular vein or temporal artery, apply a great number of leeches 
to the temples, to the epigastrium, or to the anus, according 
to the predominant cerebral, gastric, or hepatic symptoms. 

In subjects who are more irritable than sanguine, that is to 
say, whose brain is very excitable, although the arterial-system, 
the lungs and the heart do not enjoy a remarkable activity, we 
must abstain from general blood-letting, unless the face be ani- 
mated, the conjunctiva injected, and the cephalalgia insupporta- 
ble. In all other cases, topical blood-letting suffices, provided 
it be repeated as frequently as the intensity of the symptoms re- 
quire. 

In subjects exhausted by privations, by loss of blood, of pus 
or any other matter, weakened by preceding diseases, and whose 
nervous systems, and particularly, whose brains are possessed 
of an excess of sensibility, which fresh evacuations might in- 
crease, at the termination of ataxic fever, and when it continues 
during several weeks, we should generally abstain from blood- 
letting. , 

If cases occur in which it would be injurious to take blood 
even by leeches, we must not then conclude that tonics dr sti- 
mulants should be resorted to. We must here beware of making 
a false application of the tonic method, which succeeds in ataxic 
intermittent fevers. In vain may we flatter ourselves, even 
when the gastric passages appear sound, with the hope of ope- 
rating a salutary derivation. In place of procuring the displace- 
ment of the cerebral irritation, we run the risk of increasing it, 
so intimate is the connexion between the stomach and encepha- 
lon. When tonics administered in such cases produce good ef- 
fects, it is because the cerebral irritation is already on the de- 
cline. I know not whether the most imminent danger or even 
the certainty of a fatal termination, when blood-letting cannot be 
employed, or is not sufficient, excuses the administration of qui- 
nine in a disease in which an organ so important as the brain is 
violently irritated, or has already undergone the consequences 
of irritation. 



ATAXIC FEVER. 267 

If emetics are generally hurtful in adynamic fever, they are 
more so in ataxic fever, and the reason is already conceived, for 
irritation of the brain constitutes the whole danger of the latter. 
The afflux of blood towards the head, occasioned by the effort 
of vomiting, adds to the determination to the head; so that no- 
thing is more common than to sec delirium manifest itself in 
this fever immediately after vomiting. 

Purgatives would appear more appropriate in ataxic fever, 
without apparent irritation of the digestive passages; but with 
whatever rapidity they pass over the gastric mucous membrane, 
they never fail to produce a certain degree of irritation; and it is 
doubtful whether the intestinal irritation which they occasion be 
useful in ataxic fever; since, when administered in lavements in 
high doses in meningitis, in cephalitis, and in cephalic hemorrha- 
gy, they often inflame the mucous membrane of the intestines, 
without palliating the cerebral affection. I have so often found red 
patches and ulcers in the great intestine after ataxic fevers, 
which had not appeared to be produced by the lesion of these 
organs, that I shall not hereafter hazard the employment of pur- 
gatives, under whatever form, in these fevers. They have, how- 
ever, been frequently employed by M. Roche with great bold- 
ness, and he has sometimes had reason to be gratified with the 
result, never to regret the measure. 

After having laid down the general therapeutic method in 
ataxic fever, and the modification it should undergo on account 
of idiosyncrasy, it remains to point out other modifications re- 
lative to the different forms under which these fevers appear. 

In the shade which has received the name of cerebral fever, 
where all the symptoms present the sthenic character in the 
highest degree, and announce, in particular, a considerable afflux 
towards the encephalon, and often a well characterized arachni- 
tis, of which we almost always discover traces, all the resources 
of the antiphlogistic treatment should be employed. This is the 
case for bleeding from the foot, to be immediately succeeded by 
the application of leeches to the temples in great numbers; it is 
particularly in this case that we should keep up the flow of blood, 
plunge the feet in hot water, and at the same time apply ice to 
the forehead, or even over the whole cranium. If syncope su- 
pervenes, it is a good omen : we place the patient in the recum- 
bent position, remove the ice, and apply cataplasms very hot to 



268 PHYSIOLOGICAL PYRETOLOGY. 

the feet, prepared with a mixture of flaxseed and mustard. If 
after the syncope the inflammatory symptoms of the head have 
ceased, we need not return to the application of ice: if the symp- 
toms partially return, the ice should be again applied, and fresh 
leeches applied upon the legs. 

When in the midst of a high irritation which appears general, 
cerebral symptoms manifest themselves, in a word, in inflamma- 
tory ataxic fever, we must insist upon general blood-letting: 
bleeding from the foot is preferable to bleeding from the arm. 
The opening of the temporal artery is the more indicated, as the 
loss of a certain quantity of arterial blood more promptly reduces 
the vital action than the evacuation of a more considerable quan- 
tity of venous blood. In the present case, mustard foot baths, 
and particularly sinapisms should not be employed but with re- 
serve, and only after bleeding; for every stimulation, even on 
the surface of the body, may, particularly in the first moments, 
accelerate the circulation, and augment the determination to the 
head. 

When cerebral symptoms are conjoined with prominent symp- 
toms of gastritis, with or without bilious symptoms, that is, in 
ataxic, gastric or bilous fever, a problem presents itself for solu- 
tion: must we, in this case, after the example of Broussais, en- 
deavour principally to combat the gastritis, and content ourselves 
with applying leeches to the neck, or behind the ears, when the 
cerebral phenomena lead us to suspect inflammation of the me- 
ninges or of the brain itself. Should we, following the plan of 
M. Regnault, first combat the encephalic irritation by the repeated 
and large application of leeches to the temples when the symp- 
toms of gastritis are not very intense, leaving the latter to be di- 
rectly attacked after the diminution of the cerebral irritation?* 
I have often seen irritation of the encephalon disappear with ra- 
pidity, although the gastric irritation alone had been combatted; 
but I have also seen the latter diminish, and the danger increase 
because the former continued in all its violence. I have seen 
the symptoms of gastritis diminish sensibly under the influence 
of topical blood-letting from the temples, directed against the 
cerebral irritation; and even when the former did not decrease, 
the state of the patient has caused little apprehension on account 

* Journ. Univ. des Sci. Med. Sept. 1818. 



ATAXIC FEVER. 269 

of the manifest diminution of the cerebral symptoms, one or two 
applications of leeches to the epigastrium has completed the cure. 
Since I made this observation, I have very often commenced 
with the application of leeches to the temples, and ice to the 
forehead, and hot pcdiluvia, even in gastro-ataxic fever. By 
these means the cerebral affection almost always diminishes, and 
often ceases entirely. The gastric irritation itself sometimes 
disappears, or at least only continues for a few days, and we then 
have time to combat it by the application of leeches to the epi- 
gastrium or anus; the danger occasioned by the cerebral irrita- 
tion having disappeared, if not altogether, at least in a great 
measure. Such is particularly the course we should pursue in 
gastro-ataxic fevers, manifesting themselves after prolonged 
watching and excessive labour, in persons addicted to study, and 
whose stomachs are very irritable. 

It would be hazardous to imitate the example of certain en- 
thusiasts, and perceive nothing but gastro-enteritis, not only in 
gastro-ataxic fever, but likewise in all ataxic fevers; for we should 
then confine ourselves to the application of leeches to the epigas- 
trium, and the irritation of the organ whose integrity is most 
essential to life would be attacked neither directly nor with suf- 
ficient vigour. On the other hand, if, after the example of Mar- 
cus, Rasori, Clutterbuck, and George t, we see in all these fevers 
only meningitis and encephalitis, the irritation of the digestive 
passages would be neglected: this would be highly dangerous, 
since it is very frequently in vain that we directly attach ence- 
phalic irritation arising solely from gastric irritation. The opi- 
nions of these physicians, equally conclusive in their opinions 
and in their practice, are both erroneous; one by attaching too 
much importance to the organs of digestion, and the other to the 
encephalon: the latter, perhaps, succeed more frequently than 
the former, but they frequently do harm, and they fail of doing 
all the good they might effect. The wisest plan is to watch with 
equal solicitude the two organs assailed by the irritation. 

The appearance of intense cerebral symptoms in the midst of 
the mild symptoms which characterize the gastro-enteritis, to 
which the name of mucous fever has been given, constitutes 
a complication the more serious, as we cannot generally resort 
either to copious local blood-letting or even to energetic revul- 
sives, so advantageous when the brain is not greatly irritated. 



270 PHYSIOLOGICAL PYRETOLOGY. 

The highest degree of this disease constitutes one of the most fatal 
diseases to which man is subject, and one against which the re- 
sources of medicine are too often found unavailing. 

The various encephalites and meningites, simple or compli- 
cated with gastro-enteritis, with or without mucous secretion, 
and continuing for a month, six weeks, or even longer, and 
which have received, as I have already remarked, the name of 
slow nervous fever, are most frequently beyond the resources 
of medicine. Hitherto they have been treated unsuccessfully 
by tonics, and yet the opposite practice, pointed out by the na- 
ture of the disease, has not been resorted to: nor has the success 
of the latter plan yet been definitely tested by experience. It is 
however, certain that these fevers are aggravated rather than re- 
lieved by tonics. We must endeavour to sustain the patients 
with light nourishment, when the stomach permits it, and the 
skin should be stimulated, not violently, but in a continued 
manner by a succession of sinapisms, applied to different parts 
of the body. It is not yet ascertained how far or at what pe- 
riod of these fevers, more powerful derivatives might be advan- 
tageously used. 

Should the remarks on the treatment of ataxic fever be con- 
sidered too brief or unsatisfactory, and should it be concluded 
on this account that the treatment of these fevers has made little 
progress, the inference would be erroneous. I am very desirous 
not to do injustice to this part of the system which I advocate, 
and I would beg practitioners to consult experience before they 
pronounce judgment. 

It will perhaps be said by some, that with the exception of 
blood-letting, my opinion would lead to the adoption of the ex- 
pectant system: many will doubtless consider cold and hot ap- 
plications combined, as possessed of but little efficacy, and others 
will blame the caution with which I advise the employment of 
derivative applications. On these points, so numerous and im- 
portant, no single individual is competent to decide. What has 
been said is entirely conformable to the observations I have 
had an opportunity of making, and I shall be ready to modify 
my opinions, whenever more numerous observations demonstrate 
their error. But there is one point which experience has de- 
cided beyond all question; and that is, the danger of tonics in 
continued ataxic fever. Finally, whatever be the treatment 



ATAXIC FEVEli. 271 

adopted in these fevers, we cannot flatter ourselves that we shall 
frequently succeed when they are intense, and when we do not 
soon obtain a favourable change. 

When the brain is profoundly irritated, either primitively or 
secondarily, there is generally but little hope of saving the pa- 
tient, in whatever malady. This organ, forming the bond of 
union of all the other organs, ceases to act for the preservation 
of the whole economy, of which it is the principal part, when 
its own existence is endangered. Such is the sense in which 
these words should be understood: disturbance of the vital 
principle, ataxy, irregularity, perversion, disorder of the vi- 
tal j)r op er tics: expressions which give a false idea of ataxic fe- 
vers when these diseases are studied only in their symptoms. 



272 PHYSIOLOGICAL PYRETOLOGY, 



CHAPTER VII. 



Of Typhus. 



The word typhus was employed by the Greek physicians to 
designate a disease in which the external and internal senses were 
struck with stupor by a Cause affecting the brain, in which this or- 
gan is oppressed, as it were, by the smoke and soot of a sort of 
fire: this affection was considered, not so much an inflammation 
announcing itself by unequivocal signs, as a species of smoulder- 
ing fire, burning internally, and but little characterized ex- 
ternally. 

This figurative language, to which the Greeks were so par- 
tial, is not much relished at the present day. It, however, 
proves that they had an idea of the disease of which we are 
treating. 

Sauvages was the first to give to malignant fever the generic 
name of typhus: he classed together under this name the typhus 
of Egypt of Prosper Albini, the nervous malignant hectic fe- 
ver of Willis, the malignant soporose fever of Riviere, the slow 
nervous fever of Huxham, the hospital and jail fevers of Prin- 
gle, and the camp typhus of Boerhaave. 

Cullen followed closely the footsteps of the learned nosologist 
of Montpelier; for with him every fever with grave symptoms, 
or with danger not manifest, but real, was a typhus. His opi- 
nion of the grave character of the disease, and of the danger of 
the patient, is even at the present day the only idea attached to 
the word typhus by several physicians. But J. V. Hildenbrand 
thinks we should reserve this denomination to designate an acute 
disease, which is febrile, essential, special, primitive, principally 
characterized by stupor and an expression of astonishment, and 
which may be communicated to those predisposed to it, and pre- 



THE PLAGUE. 361 

cavities were examined with great care, and no morbid altera- 
tion of the viscera was discovered; every thing was natural. 

I confess it is very easy, while enjoying security, to censure 
those, who, surrounded with the horrors of the plague, had not 
sufficient resolution to devote themselves to the researches of 
pathological anatomy; I shall not, therefore, reproach MM. Ru- 
bino, Doleo, Garron and Perron: but it will be confessed that no 
positive conclusion can be deduced from two examinations so 
briefly reported, without any account of the symptoms present- 
ed by the subjects during life. We are bound, however, to con- 
cede the utmost praise to the care with which the tables of mor- 
tality, of which we have given a summary, were collected.* 

6. While the French army were in the Morea in 1828, M. 
Bobillier had an opportunity of observing the plague. Some 
Arabian slaves having brought the plague from Hydra to Argus, 
it was transported from the latter town to Vrachy by a retailer 
of clothes, who died of it. All who suffered from it contracted 
it by contagion. In all it developed itself by a gastro-encepha- 
lic irritation, the symptoms of which were those which have 
been pointed out by Chirac, Mertens, Bertrand and Desgenettes. 
In a single subject, the irritation of the brain appeared to pre- 
cede that of the other organs. In all, the buboes, anthrax, and 
carbuncle, supervened after the development of the gastro-ence- 
phalitis. Almost all the subjects perished: one hundred and 
sixty-one out of one hundred and sixty -four. 

If we institute a comparison between the typhus and the 
plague, we cannot but be struck by their surprising analogy. 
This marked analogy could not escape the observation of M. 
Desgenettes: who, in an immense and very crowded hospital, 
has seen an anthrax complicate the typhus fever, and impress 
upon it the character of pestilential fever. Since these diseases 
differ but little, since, as it regards the symptoms, there is no 
difference except in the frequency of buboes and anthrax in one 
and their rare occurrence in the other, are we not authorized to 

* Storia della Peste di Noja de Vitangelo, Morea. Naples, 1817, in 8vo. 
" La lingua presentava una cotenna formata de tre strisce, cremisi, al di 
mezzo, e biancastre a lati, sebbeni poi nel corso della malattia avese presen- 
tate altre variazioni essendo stata in alcuni biancastra ed in altri con simplici 
cotenna gialla (Doleo.) Lingua tremula, arida, giallognola; o constrisce bi- 
ancastre a lati e rosso-fosche in mezzo (Rubino.") 

46 



362 PHYSIOLOGICAL PYRETOLOGY. 

conclude, that the plague is only the highest grade of a disease, of 
which the typhus is one of the most dangerous shades, and of 
which the yellow fever is likewise a variety? 

To admit only a difference of intensity and of seat, between 
sporadic, adynamic and ataxic fevers, the typhus, the yellow fe- 
ver and the plague, is, I think, required by the knowledge we 
derive from the morbid phenomena. It is probable that this opi- 
nion would be supported by pathological anatomy in case a 
greater number of those destroyed by the plague were examined, 
and the organic alterations described with the accuracy which is 
exhibited at the present day in these researches. The researches 
of Soulier, Couzier, Deidier, and of M. Larrey, afford us a 
glimpse of such a result. The purple spots mentioned by them 
were doubtless only patches, of a more or less deep red, which 
are found on the opening of dead bodies, after many adynamic 
and ataxic fevers. The internal and external carbuncles of the 
abdominal viscera were likewise only black patches circum- 
scribed or surrounded with an areola of deep red, which are of- 
ten observed on the internal surface or on the peritoneal surface 
of the stomach and intestines, and of which, not many days since, 
I observed a striking example, in a young officer to whom an 
emetic had been given in the commencement of gastritis. The 
red, black and gangrenous spots, the manifest effects of an in- 
flammation which only ceased with life, existed also in the lungs 
and several other organs in many of the subjects, a fact which 
points out an affinity between the plague and yellow fever; ex- 
cept that in the latter the black spots are less frequent than in 
the former. 

Considered then, in its symptoms and in the morbid traces 
impressed by it upon the organs, the plague is not a disease so 
different from other grave fevers, as not to have numerous points 
of resemblance; it may even be said that the points of resem- 
blance are more numerous than those of difference. This will 
completely explain the uncertainty of physicians with regard to 
the time of its commencement and the difficulty of pointing out 
with accuracy the period of its cessation. 

After having investigated the only resemblances and diffe- 
rences by which we can distinguish between the plague and other 

* Diet, des Sc. Med. xv. p. 458. 



THE PLAGUE. 363 

destructive fevers, I shall not farther seek, in the occult causes of 
these diseases, a reason for separating them or classing them to- 
gether. A sound physiology would teach us to study the cir- 
cumstances which hasten or retard the development of diseases, 
the phenomena which characterize them, the traces which they 
leave in the body, and the comparative results of the different 
methods of practice: an investigation of occult causes should be 
abandoned to men whose fertile imagination disdains the re- 
straints of cool reason. 

M. Le Chevalier de Butel has endeavoured to demonstrate, 
that Egypt is not the cradle of the plague, and that the one 
which ravaged it in 1791, was as evidently imported from Con- 
stantinople, as that of Marseilles was from Sidon.* But, must 
we believe, that the plague does not develop itself in Egypt but 
when it is brought from Constantinople? Certainly not; for if 
the plague originates at Constantinople from a contempt of the 
laws of Hygeia, this neglect is not less great in modern Egypt. 
Most of the Mahometan countries are subject to the plague; 
they reciprocally give and receive it: the same was the case in. 
Europe before any sanitary measures were instituted. 



Treatment of the Plague. 

Since the plague seems to have developed itself in Europe, only 
in consequence of commercial relations with the east and Africa, 
until the contrary is clearly demonstrated, prudence imperiously 
demands the most scrupulous precautions in our lazarets; the in- 
terests of humanity are paramount to those of commerce. It 
is important, then, that every physician be penetrated with the 
precepts and examples given in the works of Diemerbroeck, of 
Cardinal Gastaldi, and M. Desgenettes. In their writings are 
found, not only an exposition of the precautions necessary against 
this scourge, but likewise an indication of those to which we 
must resort, when it declares itself notwithstanding these pre- 
ventive measures. Both are referrible to the general views which 
I have pointed out when upon the subject of typhus, with this dif- 
ference, that in typhus, it is less necessary to avoid the contact 

* Memoire sur le Peste, dans le Journ. Univ. des Sc. Med., xlie. vol. p. 5. 
Janvier, 1826. 



364 PHYSIOLOGICAL PYRETOLOGY. 

of patients, than the inspiration of the air which surrounds them, 
while it is necessary to avoid touching articles belonging to 
plague-patients as cautiously as the patients themselves. 

As long as the plague was attributed to a subtle poison, which 
being introduced into the human body, reached the heart and para- 
lyzed its action, it was natural to seek a mode of expelling this 
poison or of neutralizing its effects; on this account the strongest 
cordials were chosen, and especially those which were regarded 
as powerful sudorifics. It was the more readily believed, that to 
cure this disease it was necessary to expel it by the skin, as the 
appearance of buboes and carbuncles at the highest stage of the 
disease was regarded, not as a sign, but as the natural means of 
approaching recovery. What better course could be pursued, 
than to listen to the dictates of both nature and theory? Not- 
withstanding the innumerable deaths which attested at least the 
inefficacy of this method, it was as perseveringly followed as 
though it had been almost universally successful; it was, how- 
ever, perceived at last, that these cordials and sudorifics, so far 
from favouring? only embarrassed the operations of nature, and 
frequently to the great injury of the sick; that is to say, they 
died in greater numbers and more rapidly. The necessity was 
then recognised, of employing only the lightest cordials. The 
same was the case with regard to purgatives and emetics, employ- 
ed with the view of expelling the poison upwards and down- 
wards. Blood-letting, which was recommended by many phy- 
sicians, as a proper means of purifying the blood from this same 
poison, and of correcting the inflammatory and putrid disposition 
of this fluid, was copiously practised: but as it appeared very 
frequently to hasten death, it was at last abandoned. 

It appears, said J. B. Bertrand, that a disease of so extraor- 
dinary a nature, requires but few remedies, and generally those 
of a very simple and common character; a strict police, great 
care of the patients, and especially very prudent and attentive 
physicians. This physician neither rejected nor lauded any mea- 
sure: he endeavoured to turn to the advantage of the patient all 
the means afforded by pharmacy and surgery. However, it will 
be seen, that his method was not based upon the condition of the 
affected organs, although he laid down excellent principles inter- 
mingled with the most improper. 

He advised, that the abstraction of blood should never be co- 



THE PLAGUE. 365 

pious or frequent; that purgation should be gentle; that these 
measures should be resorted to only on the first day of the dis- 
ease, and not in an advanced state of the eruptions. If the pulse 
was full and strong and the headache violent, he abstracted six 
ounces of blood. He seldom repeated this measure. Afterwards, 
when the patient experienced nausea, he gave him tartar emetic; 
if of a full and robust habit, he purged with ipecacuanha: if he 
was delicate, he gave both tartar emetic and ipecacuanha, but in 
very small doses. If the tartar emetic only occasioned vomiting, 
he prescribed immediately after a gentle purgative, or a lave- 
ment. When the pulse was neither full nor elevated, he did 
not prescribe blood-letting, and he commenced the treatment by 
giving tartar emetic, always in small doses, provided this reme- 
dy was in the slightest degree indicated. If the patient was of 
a full habit, and one in whom much corruption of the primse 
viae might be suspected, he only gave a gentle purgative in a 
small dose, such as rhubarb, tamarinds, cassia, manna, syrup of 
roses. He purged no more in the course of the disease, provided 
it was not of prolonged duration, and provided the nausea did 
not continue after the emetic; for in the latter case he gave a 
purgative potion in small and repeated doses, until there had been 
two or three stools: after which, if the patient was prostrated 
and the pulse depressed, he prescribed a mild sudorific and alexi- 
teric, with which he always combined a small quantity of dias- 
cordium, to allay the effect of the purgative. He then recurred 
again to venesection, especially when there was delirium or stu- 
por or increased headache. The blood was taken from the foot. 
He prescribed at the same time simple emulsions, chicken water 
taken with moderation to prevent the too great relaxation of the 
belly; for, he remarked, it was always necessary to guard against 
diarrhoea in this disease. After the emetic or purgative, or at 
the commencement, when these means had not been indicated, 
if the pulse was very active, Bertrand prescribed toast and water 
acidulated; if the pulse was slow and feeble, he prescribed mild 
alexiterics until the tumours and carbuncles made their appear- 
ance. 

Strong narcotics threw the sick into a state of debility, from 
which they were with difficulty restored, into a fatal stupor, es- 
pecially when they were given at the decline. Bertrand em- 
ployed only the mildest articles of this class, and in small doses 



I : : PHYSIOLOGICAL PYRETOLOGY. 

in case of delirium or violent agitation. Against the diarrhoea, 
he administered diaseordium combined with absorbents: to coun- 
teract vomiting, he recommended diluents and the potion of Ri- 
E : when the latter was suddenly arrested, colic and a burn- 
ing sensation of the intestines supervened, which only ceased 
with life- A copious diarrhoea, and that which arose from purga- 
tw£s was always fatal. Hemorrhage was sometimes followed by 
recovery. Sweats which had not been strongly solicited by me- 
dicine, were a favourable sign ; when they supervened naturally, 
it was sufficient to administer, with the view of favouring them, 
sudorincs of the mildest kind, such as the water of Centaurea be- 
nedicta, powder of viper, and lilium. The cardiac and alexite- 
ric medicines were useful, only when the prostration was extra- 
ordinary. When the oppression arose from engorgement of the 
chest, he recommended small bleedings; but when it was in con- 
sequence of the suppression of cutaneous transpiration, or of cold 
contracted by the patient, in uncovering himself, or was conse- 
quent on the recession of some external eruption, he administered 
mild sudorincs. Bertrand, hence inferred that it was necessary 
to cover the patients well, and he was persuaded of the utility 
of this practice, because he observed that those who had a slight 
moisture of the skin during the disease, almost always recovered. 
The regimen was that of acute diseases generally. 

The method pursued by Bertrand, is deserving of praise on 
many accounts. We perceive that this physician endeavoured 
to avoid the excess of Chirac in blood-letting, and the impru- 
dence exhibited by other physicians in the use of emetics, pur- 
gatives, sudorincs, and alexiterics: that his talents, by no means 
of an ordinary character, enabled him to remark, notwithstand- 
ing the theories of the schools, the bad effects of the last four 
measures, and that although he did not dare to proscribe them, 
he at least used them with great reserve. The same spirit of 
observation showed him that blood-letting was indicated in some 
cases; he therefore prescribed it, but thi3 was at the commence- 
ment, and he was of opinion that it should not be abundant. 

M. Desgenettes recommended bleeding in the plague of Egypt 
when inflammation was very intense, and it was practised with 



For what reason did Bertrand administer tartar emetic and 
ipecacuanha at the same time, to persons of delicate constitu- 



THE PLAGUE. 367 

tions? Why did he resort to tartar emetic in almost every case, 
and to purgatives in all the others? This was, doubtless, in con- 
sequence of some prejudice of his medical education. We can- 
not be ignorant at the present day, why fever lights itself up 
afresh after the action of tartar emetic or a purgative, and if we 
admire the wisdom of the physician, who, under such circum- 
stances, repeated the abstraction of blood, we cannot but deplore 
the necessity which he had created. The drinks which he pre- 
scribed were most proper, but why did he fear lest they should 
induce diarrhoea by relaxing too much the abdomen? At least 
it is not difficult to believe him, when he says that diarrhoea was 
always to be apprehended; that after vomiting and purging, the 
weakness increased as well as the smallness of the pulse, and 
that mild alexiterics were probably but little adapted to the 
state of the digestive passages. Narcotics are, at the present day, 
justly banished from the treatment of delirium; we know that 
the diascordium, sometimes only suspends diarrhoea to make it 
reappear afterwards, in a more violent form; we know too, why 
acute pain in the abdomen supervenes when this medicine sud- 
denly suppresses diarrhoea: it is well known at the present day, 
that this pretended calmant, arrests diarrhoea only by augment- 
ing the irritation of the intestinal mucous membrane. 

It would be difficult to tell what difference Bertrand could 
perceive between oppression caused by engorgement of the chest, 
and that which, according to him, was caused by the suppression 
of perspiration, or by the sudden chilling of the body. In a dis- 
ease which leaves after death, very frequent traces of inflamma- 
tion, we are disposed to believe that it might be useful to pre- 
serve the patients from cold; and we may also readily believe, 
that when oppression is accompanied with signs which denote in- 
flammation of the lung, bleeding prescribed with less reserve, 
might not be without advantage. 

The local treatment of the plague, that is, the treatment re- 
quired by the buboes and anthrax, are not unimportant. Ber- 
trand reprobates the practice, equally barbarous and dangerous, 
of extirpation. 

M. Larrey applied cataplasms of squills, roasted in the ashes, 
to accelerate inflammation and induce the formation of pus. 
Without waiting their maturation, he opened them with the 
knife. When they were indolent and without any change in the 



368 PHYSIOLOGICAL PYRETOLOGY. 

colour of the skin, he employed the actual cautery, and imme- 
diately after a cataplasm. This means, which provoked inflam- 
mation and suppuration, appeared to him to contribute to the 
cure: he preferred it to caustic potash, the action of which is 
slower. He covered the carbuncles with hot and rubefacient 
cataplasms, he scarified them, cauterized them with corrosive li- 
quids, and removed the gangrenous parts with the knife. He 
thought, I know not for what reason, that the dressings of the 
buboes should not only be simple and suppurative, but tonic 
also. 

The efficacy of friction with ice, which was reported by Sa- 
moilowitz, being founded only upon three cases, in which too 
this author employed a number of other means, we must await 
the result of more extended observation, before we pronounce on 
its utility. 

Some facts seem to favour the belief that friction with warm 
olive oil may afford protection against the plague, and even that 
it has sometimes been efficacious in the treatment of this dis- 
ease. * 

"The indications," says Cullen, "to be fulfilled in the cure 
of plague, are the same as in fevers generally." The plague 
only appearing at distant intervals in Europe, physicians cannot 
do better than conform to this principle in the treatment of the 
disease. Far from obeying the pusillanimous advice of Galen, 
and imitating the timidity of Sydenham, let us always remem- 
ber this sentiment of Diemerbroeck: " Quapropter dico e locis 
pestilentia infestatis, cuilibet fugere licere, exceptis eis, qui spe- 
ciali officio proximis et reipublicse sunt devincti: quales sunt ma- 
gistrate, verbi divini ministri, medici, chirurgi, obstetrices, 
alique similes, quos pietas fugere vetat et quorum opera respub- 
lica tali imprimis tempore carere nequit." 

* Histoire Medicate de l'Armee d'Orient. 2d edit. p. 36. Paris, 1S30. 



TYPHUS FEVER. 281 

in its diverse complications, with adynamic fever, the phlegma- 
sia of the chest, or a sort of colliquative diarrhoea. In the month 
of May, it spread still farther among the attendants of the hospi- 
tal; it then extended to the apartments of the women, through 
those who had been employed in the military wards. Of eight 
physicians who volunteered their services, three died; viz. 
Dural, Serain and Blin. The attendants who had been em- 
ployed in depositing in the store-house the property of the pa- 
tients, as well as those who were engaged in the fumigation of 
the wards, were all carried off. A retired part of the infirmary 
was assigned to the women, in whom symptoms of the epidemic 
appeared. The air was renewed every half hour, continual fu- 
migation was kept up, the linen often changed, and the face 
washed with acidulated cold water. 

Pinel draws the following picture of this typhus: 
Very frequently acute headach, generally pains in all the mus- 
cles with a sort of numbness, sometimes affecting the abdominal 
limbs alone. During the excessive colds, pain in the articula- 
tions, contractility impaired or entirely gone, face presenting 
the appearance of intoxication or stupor; great difficulty of the 
movements of the tongue and of articulation; sometimes general 
trembling, acute and prolonged sensibility, which sometimes 
succeeded the torpor, and continued a long time after convales- 
cence. 2. Somnolence, from which, when the disease was not 
very intense, the patient was readily aroused, to look around 
him with an air of astonishment mingled with sadness, and to 
take the drink administered to him without appearing to bestow 
the slightest attention upon what he was doing. 3. In the greater 
number of patients a tinkling and beating noise affected the ear, 
some thinking they heard bells, others various instruments of 
music; this was succeeded by deafness; in general, there was le- 
sion of the sense of hearing, more or less marked: during the 
first days, eyes brilliant, injection of the muscles of the conjunc- 
tiva; afterwards gradual diminution of sight; delirium obscure 
and taciturn, incoherence of ideas, horrible hallucinations, an- 
swers slow, though proper, an involuntary repetition of the mo- 
tions peculiar to the profession of the patient: at the highest de- 
gree of the disease, a confused articulation of words, which were 
the more unintelligible in proportion as the tongue was covered 
with a dry and blackish coating; judgment extremely weak; 

36 



282 PHYSIOLOGICAL PYRETOLOGY. 

great difficulty in being aroused from stupor, and readiness to 
relapse into it 4. Very often a catarrhal state of the mucous 
membranes of the thorax, abdomen and throat; often complica- 
tion with gastric embarrassment, with an angina, a pleurisy, a 
peripneumony, a species of dysentery, or colloquative diarrhoea; 
involuntary stools of blackish, greenish, or yellow matters, in 
consequence of the stupor. 5. During the first ten days of the 
disease, variations of the pulse, according to the intensity of the 
disease, the state of the stomach, and the lesions of the organs of 
respiration; towards the eleventh day the pulse weak and con- 
centrated; in cases of great danger, or of complication with a 
phlegmasia^, pulse extremely accelerated, to the amount of one 
hundred and twenty or thirty pulsations in a minute; pulse some- 
times almost or entirely extinct in the arm; in women variations 
of pulse from uterine hemorrhage, which often occurred at the 
commencement of the disease. 6. Towards the sixth day, pe- 
techias, which increased and disappeared alternately, or remained 
permanent; occasionally desquamation of the epidermis; some- 
times icterus: towards the decline of the disease alarming heat of 
the abdomen or head internally. 

Of one hundred and twenty attached to the hospital, who were 
seized, only twelve died. 

A soldier presented, on the opening of the body, a congestion 
in the mucous membranes of the throat; in another was detected 
a considerable affection of the mucous membranes of the intes- 
tines. " This state." says Pinel, " might be defined not decided 
inflammation, but a species of catarrhal excitation, which is 
of no great value with respect to prognosis, provided it do not 
attain a violent degree 

Pinel mentions no other dissections. After having given a 
brief history of these memorable epidemics, I shall present an 
extract from the general description of typhus furnished by Hil- 
denbrand. This author divides typhus into regular and irregular. 
Regular typhus is announced by a change in the temper or cha- 
racter, indifference, impaired desire, lassitude, more considera- 
ble after exercise, unrefreshing sleep, foul breath, trembling of 
the hands, generally vertigo, a painful and sudden commotion in 
the limbs, pain in the loins, oppression at the pit of the stomach. 
After this state has continued from two to sei 
ease commences by a painful tension of the head, a sensation of 



TYPHUS FEVER. 283 

chilliness in the hack, interrupted with flashes of heat, tremors, 
anguish, thirst, dejection; the chills continue from six to twelve 
hours. These chills are succeeded hy a remarkable heat, sensi- 
ble to the touch, and harassing to the patient, who complains of 
chilliness in the parts which are uncovered, while the covered 
parts are burning: thirst, and a desire for cold and acid drinks 
constantly accompany the heat. Nausea and vomiting almost 
always occur, although the tongue is clean, the face red, and ani- 
mated, the tongue rather white than loaded, the skin halituous, 
urine scanty, more red and burning. The head, is extremely 
heavy, the patient experiences a sense of intoxication, and ma- 
laise rather than pain; vertigo is, perhaps, the most constant 
symptom. The stools are nearly natural, the pulse full, quick, 
never tense, not entirely free, generally depressed with a dilata- 
tion always more marked, and contraction comparatively slight. 
There is either absence of sleep, or it is unquiet and agitated. 
On the succeeding days the vomiting and sometimes the nausea 
disappears or diminishes, and the heat augments. Although the 
patients appear to sleep, they suffer from violent internal agita- 
tion; the heaviness of the head increases until stupor supervenes, 
in which the senses become extinct; noises are heard in the ear, 
vertigo increases rapidly, the debility becomes extreme, the re- 
pugnance to motion invincible, the act of speaking is painful, the 
answers are slow, and the tongue is slowly protruded: the eyes 
become redder; the membrane which covers the tongue, the 
nose, and the throat are engorged, deglutition is painful, the pa- 
tient suffers from oppression, and frequently from a harassing 
cough; the hypochondria are tense and painful, especially the 
right hypochondrium; pains are felt in the limbs, particularly in 
the calf of the leg, the joints of the fingers, in the lumbar regions 
and in the back. Towards the fourth day there is generally a 
nasal hemorrhage, which is not abundant, always succeeded by 
momentary relief: about the same time, red patches, frequently 
accompanied by small pustules or petechia?, appear on the sur- 
face: they are observed sometimes on the face, but particularly 
on the back, loins, chest, and the upper parts of the thighs and 
arms. 

Towards the end of the seventh day, a very remarkable ex- 
acerbation is succeeded by an apparent melioration of the dis- 
ease, which, however, does not often continue longer than a few 



284 PHYSIOLOGICAL PYRETOLOGY. 

hours; after which the heat augments, the tongue and skin be- 
come dry, the red patches of the skin disappear, petechias remain 
or appear for the first time, the epidermis becomes dry and wrin- 
kled, the intellectual faculties are destroyed, the appetite ceases, 
the patient no longer asks for drink; the mouth is dry, the tongue 
sometimes becomes hard, like a piece of wood; deglutition is 
difficult; the nasal cavities are obstructed by dry mucous matter, 
or blood; the oppression ceases, although respiration is higher 
and more frequent; cough ceases, and is succeeded by hiccough; 
the stools become frequent, liquid, and of a cadaverous odour. 
Pains of the intestines, at least slight pains, always appear; they 
increase when pressure is made on the abdomen, which is affect- 
ed with meteorism; the urine is scanty, pale, clear, or slightly 
turbid, and very seldom sedimentous; the pulse is often mode- 
rately strong, full and free, never small or extremely weak, of 
ordinary quickness, usually variable with regard to force; the 
diastole is constant, although the systole is scarcely perceptible, 
so that the pulse approaches that which is called depressed. We 
observe tremors, subsultus tendinum, slight convulsive move- 
ments, spasms of the muscles of the neck and of the bladder: 
hardness of hearing increases, the sight is more impaired; the 
smell, taste, touch, in a word every sense appears to be gone, 
the patients dream without sleeping (typhomania;) when they 
are half asleep, they gesticulate and talk in the most incoherent 
manner; some particular idea takes possession of them, and it 
usually is the only circumstance of their disease which they re- 
member when they recover. Their indifference to all surround- 
ing objects is surprising; they have no desires, even on the sub- 
ject of their own health. Stupor, in its different degrees, is 
generally, in all stages of the disease, the most marked and con- 
stant symptom. This state continues for about a week. Towards 
the fourth day the skin becomes moist, sometimes the hemor- 
rhage is renewed, or the nose becomes moist, the crusts which 
obstruct it are loosened and detached by the mucus secreted by 
the nasal membrane; the patient frequently sneezes, the tongue 
becomes moist, clean and more red, at first at the point, and af- 
terwards gradually towards the base. An easy and copious ex- 
pectoration supervenes, if the chest had been attacked, or the 
sputa are merely formed of thick and tenacious mucus. A trans- 
piration, or even a general sweat, halituous, and of a peculiar 



TYPHUS FEVER. 285 

odour, makes its appearance; the urine flows more abundantly; 
it becomes turbid, high-coloured and sometimes presents a copi- 
ous, whitish sediment, or a mucous cloud: there is sometimes 
diarrhoea, or only some liquid stools. 

When the disease terminates happily, the delirium ceases, the 
patient awakes as it were from a dream or a state of intoxica- 
tion, and some suddenly regain their intelligence; their looks be- 
come animated, they are astonished at every thing around; their 
insensibility and indifference disappear; the organs of sense re- 
cover their activity, but the hearing remains hard, the noises in 
the ear continue, the memory remains impaired for a long time; 
the strength is restored by degrees, the pulse becomes calm and 
equal, although it is still weak, the heart is mild and uniform, 
thirst ceases, appetite and sleep return. The sense of weakness 
which continues, is painful; every motion causes fatigue, the 
state of the subject gradually improves, the epidermis often des- 
quamates; the hair falls and the nails are changed: the appetite 
becomes insatiable, the venereal passion becomes active. There 
is generally constipation, and in women the menses are slow in 
appearing; convalescence generally occupies several weeks. 

In the irregular typhus, according to Hildenbrand, 1st, some- 
times the delirium becomes phrenitic, the stupor changes to 
apoplexy; the throat and parotids are much inflamed; sometimes 
there is a painful point in the side, with spitting of blood; in a 
word, we observe the phenomena of some local inflammation. 
2. In other cases, there are repeated vomiting, continual nausea, 
bitterness of the mouth, fulness of the tongue, oppression of 
the stomach, gastric embarrassment, pains of the intestines, fetor 
of the stools. 3. Dryness of the skin, typhomania, subsultus 
tendinum, convulsions, spasms, partial paralysis and hiccough 
sometimes make their appearance at the commencement of the 
attack, before any of the inflammatory symptoms have been ob 
served, while at other times they succeed the latter either before 
the seventh day or towards the ninth or eleventh: In the first 
case the disease may instantly prove fatal; more frequently in 
this case, and in the second there are soon observed black pete- 
chias, hemorrhages, a disposition to gangrene, diarrhoea, a cada- 
verous odour, and the fatal termination occurs before the seventh 
day. 4. The inflammatory symptoms are sometimes prolonged 
some days beyond the seventh, notwithstanding the appearance 



286 PHYSIOLOGICAL PYRETOLOGY. 

of nervous symptoms; or, symptoms of inflammation of the brain, 
the lungs, the liver or the intestines, make their appearance in 
the midst of the latter: a dysentery or an icterus is observed to su- 
pervene; the latter symptom sometimes appears suddenly, and 
likewise disappears in a short time. Worms are sometimes passed 
by the patient; petechias continue to show themselves, or they 
increase and change their aspect; the tongue is dry and hard; 
the thirst is inextinguishable, the skin dry and burning, the ab- 
domen is affected with meteorism, and is extremely painful to 
the touch; universal trembling supervenes, convulsions whose 
duration and intensity vary, delirium with gesticulation and car- 
phology, a sort of low indistinct muttering, hiccough, cramps 
in the jaws, in the neck, the bladder; palsy of the eyelids, the 
tongue, the muscles of the neck, of the sphincter of the anus; 
sometimes a rigidity of the fingers and of the extremities, a real 
catalepsy, trismus, or even hydrophobia. I observed this sym- 
tom and the desire of biting in a student, who died of ataxic fe- 
ver, brought on by excess of study and protracted attendance in 
the dissecting room. 5. On other occasions, we observe after 
the seventh day, blackness of the tongue and sordes of the teeth, 
fetor of the breath, the stools, and of the whole body; lividity 
of the skin, large petechias, hemorrhages, gangrene of the com- 
pressed parts, ammoniacal odour of the urine, a bad colour of 
the sputa, coldness of the limbs, clammy sweat, &c. These 
symptoms may develop themselves at the same time with the pre- 
ceding; none of them are incompatible with the continuance of 
many of the inflammatory symptoms. These are the cases in 
which death does not occur until the seventeenth, twenty-first, 
twenty-eighth, or even thirtieth day. 

In general, the evacuations which in regular typhus occur on 
the fourth or fourteenth day, appear in irregular typhus before 
or after these periods: they occur but incompletely or they do 
not occur at all; and when they appear they are followed by very 
inconsiderable relief, or even by an increase of the symptoms. 

After the disappearance of a part of the alarming symptoms 
in the regular as well as irregular typhus, stupor may continue, 
delirium may appear momentarily; the tongue may remain dry, 
the thirst and anorexia continue, as well as the symptoms arising 
from the affection of the chest or of the abdomen, meteorism, 
derangement of the excretions, weakness, slowness or frequency 



TYPHUS FEVER. 287 

of pulse and prostration of muscular force. A secondary dis- 
ease sometimes makes its appearance. 

During convalescence there is sometimes insomnolence, the 
appetite does not return, and the repugnance to motion continues;* 
there remains great weakness accompanied with abundant sweats; 
there is obstinate constipation; the subjects are irascible, ill-hu- 
moured and melancholy; the blistered surfaces become the seats 
of obstinate ulcers, and those of the parts which support the 
weight of the body, are cured with difficulty; the embonpoint 
and the strength return very slowly. 

Finally, there is a typhus characterized solely by a slight stu- 
por which continues fourteen days, and by abdominal pains of 
little importance. 

Such is the description of the symptoms and course of regular 
and irregular typhus, according to Hildenbrand. We shall now 
consider what he says with regard to the mode of termination of 
these diseases. 

On post mortem examination: 1. When death supervenes 
after the domination of the general vital turgescence, after ema- 
ciation and paleness of the external parts — relaxation of all the 
sphincters, coldness of the extremities, a general cold and clammy 
sweat, a small, weak, unequal, intermittent pulse, decubitus on 
the back and universal tremor; and when intelligence has re- 
turned a short time before death, after delirium and stupor, the 
parts are found soft, flaccid, without elasticity, almost friable, 
and there is an abundance of gas in the abdomen. The venous 
blood is watery, without consistence. This state is remarked in 
a higher degree in some organs which had been principally af- 
fected during the disease; for example, in the intestines. The 
external gangrenous spots are more extended and numerous in the 
parts which had been compressed before death. 2. If death 
occurs during the first days, or even at a more advanced period 
of the disease, when the face is swelled, the eyes protruded, 
the cerebral functions annihilated, and the voluntary muscles pa- 
ralyzed, the vessels of the brain and its envelopes are found en- 
gorged, and sometimes an extravasation of fluids is observed. 
3. When the cerebral symptoms have been at first extremely 
mild, afterwards more considerable and rapid in their progress, 
and those symptoms supervene which have been mentioned 
alone, if death occurs after an evacuation on the fourteenth day, 



288 PHYSIOLOGICAL PYRETOLOGY. 

we find an inconsiderable engorgement of the brain without ef- 
fusion. 4. When the symptoms of cerebral inflammation, men- 
tioned above, manifest themselves before a fatal termination, 
which occurs at a late period of the disease, and on no definite 
day, abscesses are found in the brain, or on its envelopes. 5. 
If the general accidents of a nervous state of erethism or de- 
pression have preceded the fatal termination which occurs on the 
critical days, after a high exacerbation, at an advanced period of 
the disease, we can discover nothing which could occasion death: 
softness of the brain, which some have pretended to observe, it is 
very difficult to ascertain with accuracy. This kind of death does 
not differ from the first, except as the latter supervenes in a gra- 
dual manner, while the former often occurs unexpectedly. 

The patient may perish from suffocation when the lungs have 
been affected. Death occurs in some cases very slowly, after 
vertigo, blindness, imbecility, cough, dyspnoea, chronic hsemop- 
tisis, hypochondriasis, cramps of the stomach, jaundice, affec- 
tions which indicate chronic inflammation of the brain, the 
lungs, the stomach, the liver and intestines. 

The first of these modes of fatal termination, is the conse- 
quence of excessive evacuations, of the prolonged duration of 
the disease, of too severe a diet, of deficiency of stimulants, or 
of too strong an excitement, imprudently produced: according 
to Hildenbrand, it is not the most common. The second mode 
is not uncommon, and is principally observed in plethoric sub- 
jects. The third occurs in men whose heads are weak, in men 
of science who study much, after strong moral affections, and in 
persons addicted to spirituous drinks. The fourth is not rare; 
the fifth is the most frequent of all. Death by suffocation rarely 
occurs. It must be remarked that death occurring very slowly, 
in consequence of a secondary disease, as they say, is more com 
mon than is thought. It then appears that, according to Hilden- 
brand, we most frequently find no traces on examination after 
typhus. Yet this author remarks that "the inflammatory state, 
sometimes slight, at other times severe, of the intestines, be- 
longs to the constant characters of typhus in its first period; 
that it is very seldom wanting; and that traces of it are always 
found on dissection." And in another place: " It is proved by 
dissection, that inflammation of the intestines is a phenomenon 
extremely common in typhus; and that this inflammation should 



TYPHUS FEVER. 289 

be classed among the fatal accidents which are observed, espe- 
cially when there is gangrene." He adds, it is true, that this 
inflammation produces death, by occasioning weakness, and he 
assigns to this kind of death, the lesions pointed out by him as 
observed after the first mode of termination of typhus; that is to 
say, that in observing the direct traces of inflammation of the in- 
testines, he thinks he beholds the traces of weakness produced 
by this inflammation; but at least the error here, is only in the 
explanation; the contradiction is only in the language, the facts 
remain in their purity for him who can discern them in the 
midst of this scholastic darkness.* 

Who would not be astonished at this similarity of sentiment 
which prevails among five authors, after we have rejected their 
theories, in which alone they differ. Of what importance is it 
that Chirac attributed the malignant fever of Rochefort, to the 
presence of a thick blood in the arterial ramifications, the ob- 
struction of which produced, according to him, engorgements 
and gangrene of the viscera; that Pringle ascribed the typhus of 
the English armies to a relaxation of the fibres, to a corruption 
and putridity of the humours; that Poissonnier Desperierres re- 
ferred that of the French sailors, to a diminution or suppression 
of the insensible transpiration, and to a depravation of the hu- 
mours, the evacuation of which, had been checked; that Pinel 
attributed the typhus of 1814, to adynamy; that Hildenbrand as- 
cribed the typhus, which he observed during twenty years, to a 
debility of the animal system with diminution of the muscular 
powers, and of the sense of feeling. These errors had but little 
influence upon their practice, but if they were in error with re- 
gard to the proximate cause of these diseases, if they only caught 
a glimpse of, and, if some among them entirely misunderstood 
the state of the organs affected in these diseases, they are enti- 

* It would here be proper to mention the researches of M. Louis upon the 
typhoid affection, had this not been already done in the preceding chapters. 
This physician has really confounded adynamic fever with sporadic ataxic fe- 
ver, under the improper name of typhoid affection. He has never observed 
typhus, properly so denominated, that is to say, that which reigns epidemi- 
cally. The reader of his book should not lose sight of this remark ; other- 
wise the denomination of which he has made choice, might induce the belief 
that M. Louis had seen other patients than those of la Chariti, before his de- 
parture for Spain. 

37 



290 PHYSIOLOGICAL PYRETOLOGY. 

tied to our thanks for having furnished valuable facts which 
throw light upon the nature and seat of these epidemics^ in the 
same manner as the daily observation of sporadic fevers reveals 
their nature and seat. Unless I am deceived with regard to the 
analogy of these diseases, the problem may henceforth be con- 
sidered as solved. 

After the remarks which have been made, the reader must 
doubtless think, if he at all assents to the opinions expressed in 
the preceding chapters, that 

1. Typhus fever presents no other symptoms than those of the 
inflammatory, mucous, adynamic, and ataxic fevers, diversely 
combined, but always in such a manner, that, either from the 
commencement,, or in the course or decline of the disease, the 
encephalic symptoms predominate over the others. 

2. These symptoms are but the effects either of a gastro-en- 
teritis, propagated to the liver, the brain, or the heart, or of a pri- 
mitive encephalitis, simple, or complicated with gastro-enteritis, 
hepatitis, inflammation of the skin, or with these different in- 
flammations existing together. 

3. Typhus leaves traces of inflammation, most generally in 
the meninges or the brain, very often in the stomach and intes- 
tines, sometimes only in the lungs and encephalon, often at one 
and the same time, in the encephalon, stomach, intestines, and 
lungs. 

We may conclude, that typhus is sometimes a gastro-cephali- 
tis, an entero-cephalitis, a pneumo-cephalitis, a pleuro-cephalitis, 
a hepato-cephalitis, and sometimes a primitive encephalitis, sim- 
ple or complicated with inflammation of the stomach, the intes- 
tines, the liver, the lungs, or the pleura. 

The description of typhus by Hildenbrand, directly supports 
these propositions. His description of typhus is too general 
and too abstract a picture of all the diseases which have been de- 
signated by the name of typhus. This picture is not found 
complete in nature; only its parts are there found, and for their 
assemblage we are indebted to the bold hand of the author. The 
exposition of what this writer calls the anomalies of regular ty- 
phus, presents with striking accuracy, the different diseases ob- 
served in all the typhoid epidemics. Stupor, and some other 
cerebral phenomena, were symptoms which belonged in com- 
mon to all these diseases, and in all the encephalon was a seat of 
the disease. 



TYPHUS FEVER. 291 

The observations I have made in the preceding chapters, 
with the view to demonstrate that neither adynamic nor ataxic 
fevers are referrible to weakness, and that if the word ataxy 
gives an exact idea of the apparent incoherence of the symp- 
toms, it cannot but give a very incorrect idea of the state of the 
organs affected in these fevers; and the observations there made 
with a view to prove that the traces of inflammation found after 
these fevers are not the effect of weakness, nor of the fever, 
render it unnecessary here to attempt to demonstrate that the 
symptoms of typhus, and the traces which it leaves in the body, 
do not authorize us to conclude that weakness is the proximate 
cause of these diseases. I have nothing to add to what has been 
said on this subject in the preceding chapters; the substance of 
the present chapter seems to me to furnish irrefragable proofs 
of the principles there inculcated. I invoke the experience and 
authority of past ages, of celebrated men, even of the adversa- 
ries of physiological pathology, and they attest the truth of the 
facts which I have laid down. 

With Hildenbrand, M. Broussais does not admit the existence 
of sporadic typhus; this disease depends solely, he remarks, on 
the impression made upon the economy by a miasm emanating 
from the decomposition of organized bodies, or from the body 
of a person affected with the disease. At its highest degree of 
intensity it acts violently on the nervous system, paralyzes its 
energies, and kills in a few moments without permitting any re- 
action. This state of paralysis, characterized by stupor and pros- 
tration, may continue several hours, or even several days; after 
which, febrile reaction develops itself, if the activity of the miasm 
has not been very intense. This reaction is nothing but a phleg- 
masia of the mucous membrane of the lungs, and of the gastric 
surfaces, the absorption of the miasm being affected by these mem- 
branes in a still greater degree than by the skin. Typhus is then, 
according to M. Broussais, a gastro-enteritis, generally compli- 
cated with inflammation of the bronchia. (i These two phlegma- 
sia," he remarks, " are the result of a true poisoning, somewhat 
analogous to that produced by mushrooms, or spoiled fish, and 
having all the characters of poisoning. The liver is seconda- 
rily irritated, and its secretion more or less increased. This 
irritation is the more intense as the miasm is more active. The 
brain," he says, " is not affected primitively, except in conse- 



292 PHYSIOLOGICAL PYRETOLOGY. 

quence of the moral affections, of nostalgia, and of heat; but it 
always suffers much through sympathy, and sometimes to such 
a degree, that its irritation assumes the character of a true phleg- 
masia, and becomes as serious as though it were primitive." He 
remarks farther: " The irritation of this organ, generally con- 
secutive to that of the gastric passages, is, nevertheless, fre- 
quently primitive in spring, and during the heat of summer. 
The bronchial irritation presents itself almost always in winter, 
and is, in a great measure, the cause of the extreme mortality of 
typhus in cold countries. In typhus with febrile movement, the 
principal danger is not apprehended from general collapse, but 
from the disorganization of the three principal viscera, and like- 
wise of the liver and other tissues, if they are affected. The 
fatal blow is struck during the inflammatory period of the com- 
mencement. The phlegmasia developed under the influence of 
this miasm, do not differ from other phlegmasia^, except in the 
facility with which the organic excitation ceases, and is succeed- 
ed by the torpor, called adynamic. Now, in proportion to the 
intensity of the irritation, is the rapidity of this change, as is 
likewise the case in inflammations independent of deleterious 
miasms." 

It would be wrong to conclude, that M. Broussais regards ty- 
phus as a disease, sui generis. When the period of sedation, 
which is always of very short duration, has ceased, he sees no- 
thing in the disease but a phlegmasia involving several of the 
principal organs, and eminently disposed, from its intensity and 
extent, as well as from the incessant operation of unfavourable 
circumstances, to terminate in disorganization, and the general 
cessation of organic action. 

M. Broussais has not given sufficient prominence to the con- 
stancy of cerebral irritation in typhus; it is this constancy which 
should characterize typhus, if it were rational to multiply species 
in pathology, as has hitherto been the practice. M. Broussais 
has limited too much the number of cases in which cerebral ir- 
ritation is primitive: these cases are not unfrequent, even under 
the influence of cold, which is certainly the agent most disposed 
to produce a sedative impression on the brain, and afterwards to 
occasion a high reaction in the membranes of this organ. I even 
think that this reaction is more frequently primitive in cold than 
in warm countries. The torpor into which the system is thrown 



TYPHUS FEVER. 293 

en exposure to intense cold, and the acute pain around the cra- 
nium and at its base, which succeeds, where death does not su- 
pervene during this stupor, are well known. 

It has been remarked, that Hildenbrand considers typhus an 
essential, primitive, and peculiar fever, sometimes inflammato- 
ry, sometimes nervous and putrid, and which may assume at 
once these three characters; that, according to Pinel, it is a pe- 
culiar disease, in which the symptoms of adynamy and ataxy 
continually appear, either conjointly or separately: consequent- 
ly, these two authors agree in regarding typhus as a special mor- 
bid state. 

This speciality is not demonstrated by the traces left by ty- 
phus in the body: for these are precisely the same as those of 
other fatal fevers. 

This speciality is not in the symptoms, for these are the same 
as those of other fevers, and, at the commencement, they are those 
of the inflammatory, gastric, or mucous fevers; a difference in the 
intensity and duration of the symptoms cannot constitute typhus a 
peculiar disease. Is this speciality to be found in the predisposing 
and occasional causes? This cannot be the case, since these are 
the same as those of all fevers which frequently prove fatal; with 
this difference, that instead of being confined in their operation 
to a small number of subjects, they affect multitudes, a whole 
camp, a prison, a hospital, a ship, or even a town or a province, 
although in general most of the inhabitants of these different 
places escape the ravages of the disease. 

Are the constancy of the stupor and the propagation of the 
disease the only proofs of this special character? 

But, since the predisposing and occasional causes, and the 
symptoms, with a single exception, as well as the organic le- 
sions, are identical in adynamic, ataxic, nervous and typhus fever, 
is it rational to consider the latter as a disease sui generis, because 
it is constantly characterized by a symptom, which is frequent- 
ly met with in other fevers, and which, indeed, does not make 
its appearance in every patient, during an epidemic typhus. Phy- 
sicians of the army are w r ell aware that among patients presenting 
the stupified aspect, there are always some to be found who are 
on the contrary in a permanent state of convulsion, even till 
death: shall it be said that these patients are not labouring under 
typhus, although they are attacked under the same influences and 



294 PHYSIOLOGICAL PYRETOLOGY. 

although they present the same symptoms with a solitary excep- 
tion? If it be asserted that it is not the stupor alone, but the 
union of this symptom with a fixed idea, which indicates a spe- 
cial character in typhus, this argument will convince no one: for 
it is not uncommon to observe sporadic ataxic fevers with fixed 
hallucination, the predominance of some chimerical idea, as well 
as stupor. 

Must we believe with Hildenbrand, that typhus is a peculiar 
disease, because persons in health contract it when they inhabit 
the same place with those affected. But this is a character com- 
mon to all fevers which propagate themselves in this manner. 
Now, since these epidemic fevers differ from sporadic fevers only 
in the intensity of the symptoms and the number of organs af- 
fected, it remains only to inquire why they first affect so great a 
number of patients, and why they occasion so great a mortality. 
It has already been remarked, that they are derived from causes 
whose influence extends to a great multitude: this is to a certain 
extent an answer to these two questions. Now, if it be asked, 
why persons who have experienced neither depressing moral af- 
fections, nor privations, nor fatigue, nor excessive evacuations, 
who have abstained from all excess, and have as much as possi- 
ble avoided exposure to humidity, cold and heat, nevertheless 
contract typhus from visiting places in which it prevails, or by 
receiving into their houses the affected, the answer is, that those 
who were first affected, did not contract the disease from any 
person, and that consequently in them, it was not specific: that 
others contract the disease, because it is the property of exhala- 
tions emanating from the bodies of all patients, crowded toge- 
ther in apartments without ventilation, to determine typhus in 
persons in health who respire them: if by their constitution or 
by the circumstances under which they live, they are at all pre- 
disposed to contract it. Now, the typhus of the latter and that 
■of those first affected, being absolutely the same, as it regards 
their symptoms, progress, and post mortem traces, I draw the 
conclusion that neither is a disease sui generis. 
. Typhus, developed under the influence of miasmata, does not 
differ from sporadic typhus, except with regard to the sedative 
impression, which sometimes occurs at the commencement of the 
first, and is considered by M. Broussais as a paralysis of the ner- 
vous system; he thinks that this period is generally of short du- 



TYPHUS FEVER. 295 

ration, although he seems to grant that it may last some days. 
He thus greatly contracts the duration of that state of debility, 
which, according to the pathologists of our days, constitutes ty- 
phus, from the first appearance of its phenomena until its termi- 
nation, and which, according to them, continue to exist even in 
convalescence. Yet, M. Broussais has not sufficiently limited the- 
time during which this sedation continues. In the first place, 
it is by no means observed in all cases of typhus; when it does^ 
occur, death is almost always the immediate effect; if life be not 
suddenly extinguished, an afflux of blood to the brain occurs,, 
and, if the rapid occurrence of the fatal termination does not 
permit us to find manifest traces of inflammation of the brain,, 
we observe at least a remarkable fulness of its blood vessels, a 
redness or even a general softness, which sufficiently indicates 
that the brain has suffered, and that it has not been only direct- 
ly debilitated. I do not, however, deny this debilitation, and I 
even believe it very important to recognise it with a view to the 
treatment. I, however, consider its existence as very uncom- 
mon. It is besides very difficult to know when it does occur, for 
the sudden afflux of blood to the brain may likewise determine 
the appearance of a similar torpor. We should respect its ex- 
istence, and be on our guard against it in the case of typhus, de- 
veloped under the influence of miasmata, when the disease com- 
mences with this symptom. 

Among the phenomena of typhus, there are some which me- 
rit particular consideration, since a physiological examination of 
them throws a bright light upon the nature of the exanthems. 
It has been remarked, that about the fourth day we most fre- 
quently observe the development of small spots, of a clear red, 
sometimes livid, generally rounded, somewhat prominent at their 
centres, sometimes perceptible only to the touch, varying in dia- 
meter from a line to a line and a half, numerous on the chest, 
the back, and the loins; more rare upon the belly, more rare still 
upon the arms and thighs, very seldom observed on the hands 
and feet, and still less frequently upon the face. About the 
tenth day these spots disappear gradually, leaving a desquama- 
tion of the epidermis: sometimes they disappear suddenly, at a 
much earlier period. Between these spots, we sometimes ob- 
serve small streaks, resembling those produced by intense cold, 
and small pimples, surrounded by inflammatory areolae, of little 
extent. 



296 PHYSIOLOGICAL PYRETOLOGY. 

The skin does not alone participate in the morbid state of the 
viscera; the sub-cutaneous cellular tissue, and certain glands, are 
very frequently inflamed. 

A painful swelling makes its appearance in the region of the 
parotids, sometimes in the commencement, at other times in 
the course, generally towards the termination of the disease: it 
is sometimes attended with redness, heat, lancinating pain; sup- 
puration afterwards occurs, and a spontaneous opening of the 
abscess, which is generally formed in the cellular tissue sur- 
rounding the gland, sometimes in that which enters into the 
structure of this organ; occasionally there is only pain, and no 
swelling. When this inflammation supervenes, the petechias ge- 
nerally disappear. 

I have witnessed the development of enormous phlegmons in 
the cellular tissue of the legs, sometimes after the application of 
blisters, and sometimes when they had not been applied; these 
phlegmons furnished an extraordinary quantity of pus. 

In young subjects, in whom the lymphatic apparatus predo- 
minates, the glands of the groin increase in size, and become 
painful; but these symptoms are rarely noticed by the physician: 
in the first place, because the patient seldom thinks of mention- 
ing them during the period of intensity; and, afterwards, be- 
cause the swelling disappears, or, at least, diminishes much, and 
the pain is confounded with that experienced in the loins or in 
the thighs, when the patients have recovered their intellectual 
faculties, and are capable of remarking them. I do not think 
that the frequency of these appearances have been remarked: 
having observed them in the highest degree of intensity, I am 
well assured that they occur in a great number of patients. 

Hildenbrand says, that in certain cases, gangrenous spots and 
carbuncles make their appearance. M. Desgenettes saw, in Tor- 
gau, a town in which he encountered the typhus with the same 
courage he had shown in braving the dangers of the plague in 
Egypt, a patient affected with typhus, in whom an anthrax made 
its appearance. 

The different symptoms which have been enumerated, have 
frequently caused typhus to be denominated purple, petechial, 
or pestilential fever. Some Italian physicians still assert that 
these spots, or petechias, essentially constitute typhus, and that 
the other phenomena are only secondary; but they by no means 



TYPHUS FEVER. 297 

appear in every case of typhus, and they are not the cause of 
the danger of the disease; they never precede the develop- 
ment of the disease, although, in a few instances, they are 
among the first symptoms. These spots, or petechia?, the 
inflammation of the parotids, that of the cellular tissue of the 
limbs, or of the lymphatic glands of the groin, are not the in- 
separable phenomena of typhus; they only indicate that the 
skin, the sub-cutaneous cellular tissue, the parotids, and certain 
lymphatic glands, participate in the morbid condition of the di- 
gestive mucous membrane, of the encephalon and other viscera, 
in the same manner as the different affections of the skin are the 
sympathetic signs of gastritis and chronic hepatitis. I have seen 
a woman upon whose face a large rosy blotch made its appear- 
ance every time she drank a small quantity of pure wine, and 
continued for fifteen or thirty minutes. After a strong moral 
affection, and a sudden redness of the face produced by it, I 
witnessed the development of ecchymosis, of a transient cha- 
racter, upon the delicate tissue of the skin, in a girl of seven 
years of age, possessed of great sensibility. Twice, on the re- 
turn of autumn, her skin was covered with rose-coloured or vio- 
let spots, at the same time that there were symptoms of gastric 
irritation. Petechias and inflammations of the parotids, are ob- 
served particularly in young subjects in the course of adynamic 
and ataxic fevers, which do not arise either from putrid animal 
or vegetable exhalations, nor from miasmata generated by the 
bodies of patients. I have seen, in a hospital by no means 
crowded, the sudden development of a phlegmon, below the 
left inguinal region, and the rapid supervention of gangrene, 
during the progress of a sporadic gastro-cephalitis, attended with 
irritation of the liver. 

These inflammatory affections of the cellular tissue, the skin, 
and the glands, when the digestive organs and the brain are ir- 
ritated to a high degree, are facts, the explanation of which we 
must seek in that incontestable law of the organism, in virtue of 
which, irritation manifests itself in several organs with a facility 
proportioned to its intensity and extent. Hildenbrand was well 
aware that, to account for the production of typhus, it is not 
necessary to suppose an absorption of the emanations or mias- 
mata. 

To what distance can putrid vegetable or animal effluvia be 

38 



298 PHYSIOLOGICAL PYRKTOLOGY. 

transported, or miasmata exhaled from the bodies of men in 
health, too closely confined, or from patients generally, or ty- 
phus patients in particular, without losing the property of de- 
veloping grave diseases or typhus? Can they be conveyed to a 
distance by merchandise or clothes? Can they be carried by ves- 
sels over the ocean? It is not possible to answer most of these 
questions, except by conjectures, because they can be but indi- 
rectly submitted to the test of experiment Were these mias- 
mata visible, or were they possessed of any peculiar odour, the 
solution of these problems would present no difficulty. A dis- 
ease appears in one country, and shortly after manifests itself in 
another: would it have appeared in the latter, had all communi- 
cation with the former been interrupted by land, by water, and 
even by the atmosphere? If the disease be transmitted from one 
country to another, in what manner is this transmission effect- 
ed? We are not possessed of sufficient data to render the solu- 
tion of these problems practicable. 

It is impossible to determine to what distance effluvia from 
marshes, common sewers, camps, cemeteries, hospitals, prisons, 
or ships, may be carried by the winds. It is probable that the 
same blast that wafts them to a distance, disperses them at the 
same time: unless it be in a valley, or a long and narrow defile. 
We do not know at what degree of rarefaction these effluvia be- 
come innoxious. All that is known upon this subject, is, that 
epidemic and malignant diseases have developed themselves in 
places exposed to winds blowing from a marsh, an hospital, a ce- 
metery, or a vessel, &.c. 

Miasmata generated by healthy human bodies, confined too 
narrowly together, do not appear ever to extend to a distance: 
it is sufficient precaution against their action to avoid approach- 
ing the door of the apartment on the instant of opening it, and 
to keep the windows open. 

The effluvia from the bodies of patients labouring under 
sporadic fevers of slight intensity, moderate phlegmasia? of the 
head, chest, or limbs, have in general, but little injurious effect, 
even on the persons who sleep with them. But when a great 
number of patients, of whatever kind, are crowded together in 
a close place, without sufficient ventilation or attention to clean- 
liness, the symptoms become aggravated, and the phenomena of 
typhus manifest themselves; especially when the patients are af- 



TYPHUS FEVER. 299 

fected with gastro-enteritis of great intensity, and accompanied 
with adynamic symptoms. Almost always, some of the physi- 
cians, surgeons, or attendants, and even the apothecaries, who 
usually do not touch the patients, as well as visiters, who remain 
but a short time, contract the typhus. 

On returning to their homes, they frequently communicate 
the disease either to those who are constantly with them, or to 
those who are in their company even for a few moments, when 
their disease is intense, and proper attention is not paid to venti- 
lation and cleanliness. 

Is it possible for a man, coming out of an hospital or chamber, 
in which typhus prevails, to communicate the disease without 
having contracted it himself? It is not probable, that this can oc- 
cur, or certainly it has not frequently occurred; for it appears 
that those who inhabit the same house with physicians, or who 
frequent it, do not contract the typhus when the latter are not 
affected. 

From these observations, we should be led to believe that 
stuffs and clothes are little capable of becoming the media of the 
propagation of typhus: but, if this be true with regard to the 
clothes of persons visiting the sick, the same does not appear to 
be the case with the effects of the patients. The wounded, 
placed in a chamber which, within a short time, has been occu- 
pied by men affected with typhus, soon contract the disease, if 
the bed-clothes have not been perfectly cleaned, and the air of the 
apartment entirely renewed; now the communication of typhus 
in this case cannot be attributed solely to the latter circumstance. 
Hildenbrand thinks that typhus miasm may retain its activity 
for three months, without, however, assigning any reason for his 
opinion. Are these miasmata dangerous, and do they retain the 
power of producing typhus, in proportion to the length of time 
during which the substances to which they adhere, have been 
confined in a close place? This is probably the case, although 
we must not attribute too great an influence to miasmata: they 
possess but little when local circumstances and the state of the 
atmosphere do not favour the development of the disease. 

The epidemic, described by Poissonnier Desperierres, proves 
that the typhus of ships may communicate itself to the inhabi- 
tants of a port, and that the propagation of the disease is effected 
in the same manner as among land forces. 



300 PHYSIOLOGICAL PYRETOLOGY. 

Putrid effluvia, and miasmata are not the only cause of typhus; 
this disease manifests itself, as I have already said, under the in- 
fluence of all those causes, which occasion sporadic adynamic, 
and sporadic ataxic fevers. Among these, some are more fa- 
vourable than others to the development of typhus, and the in- 
direct production of the miasmata which propagate it: these are 
unwholesome provisions, dampness, depressing moral affections, 
circumstances, without the existence of which, the typhus 
miasm is innoxious, and which, without the occurrence of these 
miasmata and putrid exhalations, can originate typhous epidemics. 
M. Desgenettes has remarked, that prolonged humidity may su- 
peradd to the phenomena of typhus, some of those of the 
plague. 

Upon what organ do putrid effluvia and the typhus miasm pri- 
mitively act? This question is not of easy solution. The skin 
absorbs but little: the mucous membrane of the nasal fossae, of 
the mouth, and of the air-passages absorbs more: absorption is 
of great activity in the mucous membrane of the digestive canal; 
but the bronchial surface is more exposed to the influence of the 
miasm, than the others; and, consequently, if it be ever demon- 
strated that these exhalations really penetrate into the veins, and 
are conveyed into the whole arterial system, we must conclude, 
that they enter into the organism through the lungs, whence they 
are transmitted to the heart, the brain, the digestive organs, and 
other parts of the economy^. But there is no certainty that they 
are absorbed, and their morbific action generally manifests itself, 
first, on the gastro-intestinal mucous membrane, which, how- 
ever, can be directly affected but by the small quantity of dele- 
terious gas with which the saliva and food are impregnated. It 
may here be remarked, that animal substances in a state of pu- 
trefaction have been injected into the veins, and have occasioned 
inflammation of the viscera. * 

Until it has been demonstrated, that it is not the skin which 
transmits the miasm to the organism, it will be proper to pre- 
serve it as much as possible from their impression; but it would 
be both absurd and dangerous to neglect such precautions as may 
protect the bucco-bronchial membrane. It is much to be de- 
sired, that the part performed by this membrane and the skin, 

* Majendie, Gaspard, op. cit. 



TYPHUS FEVER. 301 

in the development of typhus, were exactly known, when it re- 
sults from these effluvia, as we should then better know what 
precautions were proper against their action. We, however, 
must not neglect those measures which prudence points out; 
while, at the same time, the physician must not permit any fear 
of personal safety to interfere with the discharge of his profes- 
sional duties. 

It is much more important to know, with a view to practice, 
what are the organs affected in typhus, and to ascertain the man- 
ner in which they are affected; for this is the only source from 
which we can derive the indications, to be answered in all dis- 
eases of whatever character. 

I have pointed out the measures which government should 
pursue, to preyent the development of epidemic adynamic fever: 
the same precautions should be taken against the development and 
propagation of typhus. I shall only add in this place, that when 
typhus originates from the effluvia of a low, damp, or marshy 
soil, conjointly with a high atmospheric temperature, and when 
the disease has made its appearance in the badly built, filthy, 
damp, and very populous parts of a town, the inhabitants should 
be obliged to desert their habitations, and take up their abode, 
not in the neighbouring towns or villages, but in barracks con- 
structed with the utmost care, and if the country permits, situ- 
ated upon an eminence. 

When typhus develops itself under the influence of humid 
cold, the inhabitants generally shut themselves up in confined 
and heated apartments, and thus become more susceptible to the 
causes of the epidemic. Recourse cannot, however, be had to 
the measure which has just been pointed out, for by this means 
they would be still more exposed to the action of cold and hu- 
midity: all we can do in such cases, is to prevent their commu- 
nication with the sick, and to keep the latter separate. 

The application of these precepts presents great difficulties, 
especially in the details. We must either abandon a frightful dis- 
ease to itself, and permit its extension, or inspire the inhabitants 
with a sense of fear, which is one of the conditions most favour- 
able to the development and propagation of epidemics. 



KB PHYSIOLOGICAL PTBBTOLOGY. 



Treatment of Typhus. 



7; -r:-e :b :.: .be::.-e .::.; rr.e;.5-re 5 : .we ^-"75 beM :";■_•- fe : 
-•:: :i'i:'.:i'.:£ :be-::\e.5, if :fr:;..z".7 :: :ez::zf;r'i:e :hi: -.jiii 
dependence will always exist; and consequently, that it is im- 

p: ::.;..--. :: hive ibe r:;5: iebii.e :ie.ii ::' ±e :::::r nd se:,: ■::" 



7: :;-;':;.: :be be:.: :~i rire:*.i:r.:z ::" :b.e :.:•■:•:. izi :: pre- 
vent its Tiscidity; to gire a shock to the lirer and longs; to de- 

:':f-::: :be Ti.5.5c.i ~bi:b i-i— ;b.e b'.e. i-i '•: ~r:~ ::e i.f d:~; 
to diminish the distension of the Teasels and remedy the inflam- 

z:.:.'.:t~ :..*z:s.:.:z :: ' ~1~. e ~;5:t::. iz\i ::i.:;.:;::i:::i ::: :i:-:- 
nil :::,.::::::.::; :: 7. 5-:~e :be ':.:•:£ :::~ Lie il:e:;.:::i3 
which might be occasioned by bad ferments contained in the 
stomach and intestines; finally, to prerent the rupture of the 

v=i.5«rlf ::' :b.e ':.-:::. :z- Liver :.::i i i^es ~e lez.-.L. :,:.'. -.be e:e- 
s;;r. ::*:be -err : re zee ::' :b.e ie::er: .iieee ~-f:e :b.e iziber. :ns 
"v..:;-. 7 bin: :;.::::: —ere :: :e L-bbiie:. '"■"::'.-. :;..5 v_e--. be 
ri:::::^:^: bie-e-iibz :i::~ ±e :":•::, e~_e:i:5, z .:: zeeivef. z...- 

..'. . : : .':..1.5 5'..;: .-.'.- :,.: ;z:::.:. :: •.'.•.iff : veze- 

ubiei rep-:ei zz:.-5; ;:": .::.:. :ili, r.bzzziib.5, 50z:e:;zzee i5:r;n- 

pulse was d epre ssed, with cold skin, and when, in a word, reac- 

:.: 1 b 1 :. z: : ve: :eez if .zbizsize ':.. be zreeer:': -. i : :ize 

;e zbee :: : z :■: z ■ ... z zb . 5 :.i'; : z . biz zzz. zzz . 5 zi zz: z: : z z\ :. A: :ez- 

• ' ~bez zze ski- be ::.:..: -.- = zzve zze :e::::_:z : ;' 

zer. ::±e ;::;: zeiizezize, zze "\i:i ezi.ve. 5:r;.--z:e::y. zze ve- 



e i:- 



;: -.7 :'.:::. ::i:ze ; :' zze vz>: en zz:e: irrizr.eb. :: '5 ::':;: 
:r.5.5.iT7 :.; rezez: .: severzi zizzei ::. :ize 5; :e :: :--ez7v-:':zr. ;r 
even :: r^e>e b: .::5. ;.::-: :: :~ ezrr :_.~:ef ::' :.::.; 
en--;: rve:7 ;:..; : i ;. :.;:5, .:::;b :be pu£i«e r-ei-izie !eif " 



-jlsive, be ;b- 






TYPHUS FEVER. 303 

veins of the arm or neck. To prevent syncope, he made the pa- 
tient lie with the head depressed, with a little water or wine in the 
mouth; abstracting only one or two ounces at a time, or twelve 
or fourteen ounces in a quarter or half an hour. Immediately 
after the bleeding, on the first or second day he gave to vigo- 
rous adults from four to six grains of tartar emetic in four or 
five spoonfuls of broth: to delicate individuals he gave but four 
grains of this salt in two or three ounces of manna: he after- 
wards administered a mucilaginous or slightly aromatic drink. 

When the patient had been badly, nourished, and the pulse was 
feeble and soft, he abstained from the abstraction of blood, and 
immediately resorted to the tartar emetic. 

When, after having employed these different means, the face 
was wan and leaden, the eyes dull and sunken, the pulse small, 
frequent, and unequal, and the habit of body cold; when there 
was continual faintness, nausea, vomiting, colliquative diarrhoea, 
serous, green, black, and bloody dejections, an extraordinary 
prostration of strength, an intolerable weight of the head, re- 
sembling drunkenness; although the measures which have been 
pointed out, still appeared to him to be indicated by the nature 
of the disease, he still had recourse to those which he employed 
before the establishment of the reaction; that is to say, to lilium, 
sal ammoniac, saffron, &c. 

Independently of this general method of treatment, he parti- 
cularly recommended tartar emetic, purgatives, diascordium, the 
diaphoretic antimony, diacodium, laudanum, carbonate of lime, 
oil of sweet almonds, manna, the sub-carbonate of potash, Arme- 
nian bole, ipecacuanha, infusion of the Provence rose, balaustium, 
sumach, and emollient lavements, as remedies for the diarrhoea, 
according as it was stercoraceous, lienteric, bilious, or atri-bilious. 
W r hen there was prostration, he sometimes administered lave- 
ments of putrid wine, or of wine mixed with theriaca. He com- 
bated constipation, suppression of urine, hemorrhage, nausea, 
and vomiting, as well as the delirium and stupor occasioned by 
phlegmonous inflammation of the brain, by bleeding, emetics, 
and purgatives; and the stupor caused by phlegmo?io-03dema~ 
tous inflammation of the brain, by the lilium, sal ammoniac, &c. 

Who could believe after what has been said, that Chirac was 
desirous that as much care should be taken to prevent gangre- 
nous inflammation of the stomach and intestines as that of the 



304 PHYSIOLOGICAL PYRETOLOGY. 

brain and liver? He earnestly recommended to commence by 
blood-letting, and to repeat the measure as often as the intensity 
of the symptoms demanded it, at whatever period of the disease, 
except when there was no reaction either at the commencement 
or towards the decline. He recommended the internal use of 
narcotics, when the viscera were irritated; and he remarked that 
the viscera are often engorged and inflamed, even when the pres- 
sure of the abdomen did not appear to occasion any pain. He 
censured the employment of strong cordials and diaphoretics, 
and strenuously opposed the practice of the English and Ger- 
man physicians; who, beholding in malignant fever only the ef- 
fect of a subtle poison, w r ere profuse in the use of alexiterics. 
In the case of nausea and vomiting, he insisted upon bleeding 
and emetics; and, with singular inconsistency, approved of food, 
and even of broth. 

It is evident that Chirac, blinded by a humoro-chemical the- 
ory, could not properly avail himself of his valuable experience 
in pathological anatomy, and that instead of banishing from the 
treatment of the fever of Rochefort, the confused polypharma- 
cy of the school of Galen and Paracelsus, he merely insisted 
more strongly upon blood-letting than had generally been done. 
But he had the judgment not to abstract much blood at one time; 
which, to a certain point, was equivalent to the application of 
leeches: this method should always be employed when these 
animals cannot be obtained. Although he employed the means 
calculated to inflame the gastric mucous membrane, while his in- 
tention was to prevent its inflammation, the copious abstraction 
of blood enabled the digestive organs to suffer these incendiary 
measures with less injury. His manner of abstracting blood, 
debilitated the circulatory action less than the large and sudden 
loss of blood. In this manner may be explained the success of 
Chirac in the treatment of this disease. Many of his opinions 
are still entertained: we hear some physicians insist much upon 
the necessity of emptying the vessels; but this theoretic view 
belonged more to Boerhaave than to Chirac, who applied the re- 
marks of the professor of Leyden to most fevers. 

Did bleeding from the foot, which was preferred by Chirac, 
produce a less sudden depression of the circulatory action? This' 
I cannot affirm: yet I am inclined to believe, from many facts, 
that this mode of bleeding is too much neglected at the present 
day. 



TYPHUS FEVER. 305 

Chirac has acknowledged that in certain cases blood-letting 
was not indicated: it is probable that the inconsiderate disciples 
of this great man did not regard either this exception, nor the 
slowness which he advised in the abstraction of blood. The 
abuse of a measure, good in itself, led gradually to its total re- 
jection. 

Pringle has greatly limited the number of cases in which 
blood-letting should be practised. " When the fever of a marshy 
country is of an ardent species," he remarks, "it appears to re- 
quire copious venesection; but, in general, it does not admit of 
so free an employment of this measure as the fever of camps. 
In most cases it is necessary to open a vein at the commencement 
of the attack, or on the day following; but repeated blood-let- 
ting may render the fever still more obstinate." Immediately 
after bloodletting, when he considered it proper to practise it, 
he administered senna and the nitrate of potash; the next day he 
gave a grain of the tartrate of antimony and potash, with twelve 
grains of carbonate of lime, and in three hours after, a second 
grain. He sometimes preferred twenty-four grains of ipecacu- 
anha, with two grains of the tartrate of antimony and potash, in 
a single dose. At other times, he prescribed six grains of this 
salt, in a pint of hot water, which the patient took in doses of 
four or six ounces, every ten minutes. When he wished to re- 
peat the evacuation, he gave half an ounce of some purgative 
salt, with tartar emetic, in the dose I have mentioned, in the 
same quantity of water. When these means were insufficient 
to arrest the progress of the disease, he prescribed bark in the 
dose of an ounce and a half, in half a pint of wine, or an electu- 
ary, composed of an ounce of quinine, a scruple of sal ammoniac, 
and a small quantity of rhubarb, and afterwards the bark alone. 
When there was delirium or pain of the head, he applied leeches 
to the temples, and a large blister between the shoulders; he 
then confined himself to the employment of gentle emetics, re- 
peated lavements, and mild purgatives. " The principal rule," 
he remarks, " should be to, disembarrass the primas viae, and 
.for this purpose, the exhibition of tartar emetic, with a purga- 
tive salt, would probably be the most effectual measure." When 
he thought the digestive organs contained worms, he prescribed 
twelve grains of calomel, and half a dram of rhubarb. 

In the fever of prisons and hospitals, besides attention to clean- 

39 



306 PHYSIOLOGICAL PYRETOLOGY. 

liness and ventilation, Pringle recommended, at the commence- 
ment, an emetic, and, afterwards, half a grain of the theriaca, 
with ten grains of the carbonate of ammonia, and a few glasses 
of whey; in the evening he repeated the latter medicines. When 
the fever manifested itself, if the pulse was full, he abstracted a 
little blood; and, however violent the symptoms might be, he 
very seldom repeated the blood-letting, even to a moderate quan- 
tity. 

When the head was painful, he preferred the application of 
leeches to the temples to venesection: — "But," he remarks, 
"in delirium, with depressed pulse, leeches are of no use;, and 
I am inclined to believe that they are sometimes injurious." 
Sometimes he gave a second emetic at the moment the fever was 
lighted up. He afterwards prescribed sal ammoniac, provided 
there was not already a diaphoresis; and when the disease was 
confirmed, he confined himself to the administration of the pow- 
der of contrayerva, nitre, camphor, and barley water, acidulated 
with vinegar. 

After the lapse of three or four days, when the pulse became 
feeble, the stupor more profound, and petechias began to appear, 
he had recourse to the serpentaria of Virginia, to quinine, and 
wine. If delirium increased on the use of wine, if the eyes ap- 
peared wandering, and the speech short, he renounced this mea- 
sure, and had recourse to blisters, continuing the employment of 
whey, camphor, powder of contrayerva, and nitre. If delirium 
was accompanied by slowness of speech, and without violent 
agitation, he continued the decoction of bark and serpentaria, to- 
gether with wine. To moderate the diarrhoea, he prescribed a 
few drops of Thebaic tincture, or a julep of carbonate of lime 
with chalk; finally, he opened the tumour, formed by the in- 
flamed parotids, before there was any fluctuation. 

All this apparatus of medicine was destined to retard the pro- 
gress of the putridity of the blood, and the effects of that of 
the humours accumulated in the primse vim: such were the 
sole indications which Pringle endeavoured to answer. As he 
opened but a small number of bodies, he was not so much struck , 
with the traces of inflammation as Chirac had been. His plan 
of treatment w r as infinitely less regular than that of the French 
physician. If theory is less predominant in the writings of the 
English than in those of the French physician, we find in the 



TYPHUS FEVER. 307 

former but a weak exposition of the treatment, in a succession 
of assertions too general and vague. 

More timid, and less skilful than Chirac in the employment 
of blood-letting, Pringle strengthened with the whole authority 
of his name the prejudices against this operation, which Van 
Helmont had disseminated. He had not the happy idea, of not 
permitting the blood to flow except very gradually, a precaution 
very proper, with a view to guard against the injurious effects 
which might result from the abstraction of a great quantity of 
this liquid. What more inconsistent than to prescribe the the- 
riaca and whey with tartar emetic? What more contrary to sound 
experience, than to bleed, after having given in succession tartar 
emetic, and the theriaca. The prejudices of Pringle against the 
effects of leeches, arose entirely from his employing them with 
too much timidity, for he only employed two or three each time: 
if he sometimes used as many as six, it was only in primitive 
inflammation of the brain: it is probable that he was not so bold 
in his practice in the hospital fever; this we may the more rea- 
dily believe from the fact, that in ophthalmia, he never applied 
more than two of those animals to the internal angle of the dis- 
eased eye. It is true, that at the commencement of this inflam- 
mation, and of that of the brain, he bled from the arm several 
times. Since, he very seldom practised venesection in the fever 
of the hospital, it is easy to explain why it appeared to him that 
the application of leeches was often of little benefit, and some- 
times even hurtful in this disease. 

Bold practitioners bring into disrepute therapeutic agents, by 
employing them with too much freedom; while, on the other 
hand, timid practitioners produce the same result by prescribing 
them in insufficient doses. From the same means becoming dan- 
gerous in the hands of the first, and useless in those of the se- 
cond, the conclusion is drawn, that they are prejudicial in all 
cases. 

Poissonnier Desperrieres was of opinion, that in vigorous sub- 
jects, the vascular system should be placed in a state to form 
that unctuous fluid which should operate a salutary crisis, 
and that in those disposed to scorbutic cachexy, while the prin- 
cipal disease was combated, measures should be taken against 
the ulterior depravation of their humours. His method dif- 
fered little from that of Pringle, that is to say, it consisted of an 



308 PHYSIOLOGICAL PYRETOLOGY. 

emetic in all cases, blood-letting sometimes, and universally of 
purgatives followed by bark. He preferred ipecacuanha to tar- 
tar emetic: he prescribed sulphuric ether, given by drops on su- 
gar and acidulated drinks, 

Pinel recommends, in the treatment of the fever of jails and 
hospitals, the same means which he thought were indicated 
against ataxic fever in general. He advises, in general, to ex- 
::■:• vomiting, and immediately afterwards to have recourse to a 
tonic medication, that is to say. after the exhibition of an emetic 
he would resort to the profuse use of generous wines in repeated 
doses, alcohol, camphor, ether: the volatile oils, ammonia, acetate 
of ammonia, the alcoholized mineral acids, punch: aromatics, 
such as serpentaria, valerian, chamomile, and especially bark, in 
concentrated decoction, in water acidulated with sulphuric acid, 
lemonade, wine and water, light wines or beer, more or less di- 
luted. Who does not in this treatment recognise the plan of 
Pringle, with the exception of blood-letting, the most efficient of 
all the measures recommended by the English physician ? What 
could have induced Pinel to discard blood-letting? Probably the 
theory of Brown, which, without his being conscious of it, might 
have influenced his judgment, and supplanted the opinions of 
Pringle. Putridity ceased to engage the attention of the physician, 
and debilitv took its place: thus we observe, that no sooner had 
science renounced one absurd hypothesis, than it was destined 
to fall under the dominion of another equally inadmissible, and 
perhaps more dangerous. From that period, physicians at- 
tempted to combat debility by giving bark in dram and ounce 
doses, and lemonade by the pint: it would appear that there is 
some provision in the constitution of things, by which the inju- 
rious results of erroneous theories are neutralized by a fortunate 
inconsistency between the theoretical views, and the practical 
measures deduced from them. 

Blisters, so liberally employed by Pringle in the second pe- 
riod of nosocomial typhus, were equally used by the disciples of 
Pinel; but since he applied them, when vitality was on the point 
of becoming extinct, and not when the circulation was still in a 
state of sur-activity, they were in his hands rathe: - than 

udicial. 

It has been advised, to administer a few glasses of generous 
wines, or a small quantity of some alcoholic liquid, on the first 



TYPHUS FEVER. 309 

appearance of the symptoms of typhus. Some physicians think 
that within the first twenty-four hours, the source of this infec- 
tion can, in a great measure, be expelled, or the disease rendered 
more benign by provoking vomiting, or sweat, when, in this 
space of time, symptoms more or less grave have developed 
themselves, under the influence of deleterious miasmata. Thi3 
opinion supposes two things; the first is, that these miasms still 
adhere to the walls of the stomach, and that they can be expelled 
by the mouth, or eliminated by the skin, after traversing the 
whole thickness of the body: the second supposition is, that the 
effect of these miasms is to debilitate the gastric mucous mem- 
brane, and thus render the employment of tonics proper. But 
nothing proves that the miasmata remain in the stomach, and 
still less does it appear that it is possible to expel them by eme- 
tics, or sudorifics. Those ideas are derived from the compari- 
son which has been instituted between these miasms and poi- 
sons, a comparison more ingenious than solid: in very few cases 
of poisoning are emetics indicated, and certainly in none can to- 
nics be resorted to with propriety. Were it true, that the only 
effect of these miasms is atony of the stomach, why not continue 
the use of tonics? why not from the first have recourse to the 
strongest stimulants, and in the highest doses? Is it not singu- 
larly inconsistent to recommend, as has been done, mucilaginous 
and acidulous decoctions, after vomiting? Nothing more deci- 
dedly proves the danger of tonics than this precept of Pinel. 
" It is in the second period, and when the symptoms are most 
intense, that it is necessary to make use o vinous drinks, and 
even of generous wines, administered at intervals." It appears 
then, that there was some vague notion entertained of the dan- 
ger of tonics after the commencement of the disease, but there 
was an entire ignorance of their noxious effects at its most in- 
tense degree. 

As the method of Hildenbrand contains nothing but what is 
either vague, or perfectly similar to those of Pringle and Pi- 
nel, instead of giving the few rules, and multiplied exceptions 
of the professor of Vienna, I shall confine myself to an exposi- 
tion of the manner in which he treated himself when affected 
with the typhus, in 1795. " Whether owing to delirium, obsti- 
nacy, or a distrust of the powers of medicine, I took nothing 
during my disease but lemonade, and barley water, with the ex- 



310 PHYSIOLOGICAL PYRETOLOGY. 

ception of an emetic which I prescribed for myself at the com- 
mencement, after venesection. I, however, triumphed over the 
disease, and, after a favourable crisis, which supervened on the 
fourteenth day, I was perfectly restored. I owe my recovery 
to no exciting means, such as wine, and my mind was at that 
time in a state unfavourable to recovery." This narration is re- 
markable on more than one account; it is in direct opposition to 
the remarks of Pinel, with regard to the ataxic fever which he 
contracted in 1793. " I escaped death by means of an excellent 
wine, which was administered in small doses at short intervals." 

The remarks of Hildenbrand prove that the abstraction of 
blood is not always opposed to the development of a salutary 
crisis: that blood-letting may sometimes be efficacious, although 
the patient be suffering from depressing moral affections: that 
this physician had no great reliance upon the efficacy of the tonics 
which he recommended in his work; that an emetic, after which 
the disease continued fourteen days, certainly did not abridge, 
though it may have lengthened, the duration of the disease. If 
we refer to what follows the preceding account in the work of 
Hildenbrand, we shall be induced to inquire what could induce 
him to recommend tonics, in a disease generally owing, in a 
great measure, to inflammation of the stomach: "I have several 
times seen," he remarks, "patients attacked with common sim- 
ple typhus, who perfectly recovered under the use of lemonade 
alone." If co?n??ion simple typhus, that is, typhus which ac- 
cording to the Brunonian view, depends entirely on debility, 
is cured by employment of an acidulated drink; what strange 
inconsistency could lead to the employment of tonics and stimu- 
lants in complicated typhus, that is, typhus in which we cannot, 
without shutting our eyes against all evidence, but recognise the 
inflammation of one or more organs, even when we consider the 
disease as a general affection? 

Let us contrast with these ineffectual essays of practitioners, 
skilful, but seduced by erroneous theories, the therapeutic me- 
thod of M. Broussais. 

Where as yet there is only malaise, dejection, slight febrile 
movements, anorexia, and lassitude, alcoholic or sudorific drinks 
cause the cessation of these symptoms in some subjects; while in a 
greater number they increase the intensity of the disease, and 
we succeed better with mucilaginous drinks and the acids. When- 






TYPHUS FEVER. 311 

ever the disease develops itself in the digestive organs, when 
there is pain, epigastric uneasiness, diminution of muscular force, 
and contraction of the pulse; internal stimulants are never proper, 
whatever he the degree of prostration; acids, on the contrary, 
are beneficial. If stercoraceous, bilious, and fetid matters are 
copiously evacuated, acid purgatives will give relief, while they 
increase the sensibility of the abdomen and the meteorism, if these 
symptoms depend on inflammation of the peritoneum. If the 
chest be particularly af%jted, and the pulse large, venesection is 
not to be practised; but local bleedings are to be employed, suc- 
ceeded by stimulants to the inferior members. When the brain 
is more affected than the other organs, if the blood is impetuous- 
ly determined towards it, blood is to be taken from the foot or 
leeches applied to the head and afterwards to the feet, and sti- 
mulants are then to be applied to the inferior extremities: cold 
water should be poured upon the head while the feet are plunged 
in hot water. If the circulatory motion is, as it were, annihi- 
lated, and the patient plunged into an apoplectic condition, blis- 
ters should be applied to the head and excitants of the inferior 
portion of the digestive canal employed. Wine and other sti- 
mulants, should not be given internally except in one of the four 
following circumstances: 1st, When there is general weakness 
and stupor, with a tongue but slightly red, and without any sign 
of phlegmasia of the three cavities; 2dly, When these means, in- 
stead of rendering the tongue dry and incrusting it, the thirst 
ardent, the skin hotter, and the nervous movements more fre- 
quent, procure a diminution of these symptoms; softness of the 
pulse, and dispose to a salutary diaphoresis: we must, however, dis- 
continue their employmentwhenever sur-excitation is announced 
by the skin, the pulse, the tongue, and by general uneasiness: 
we then resort to the employment of acids, resuming our former 
measures, whenever they are again indicated; 3dly, When the fe- 
brile period has terminated, and the patient falls into extreme 
debility, which can no longer be attributed to an inflamed organ, 
that is to say, when the first moment of convalescence has arrived, 
we must be guarded in the employment of stimulants, lest we 
dissipate, by a strong excitation, the small degree of strength 
which still maintains vitality: finally, When there is no farther 
hope, and congestions increase with astonishing rapidity, not- 
withstanding the employment of the most powerful revulsives. 



312 PHYSIOLOGICAL PYRETOLOGY. 

"The latter case.'- adds M. Broussais, "is one of extreme de- 
licacy: this desperate method, which is often too soon resorted 
to, has destroyed more than it has saved: after having adopted it 
in the case of certain patients, of whose recovery I despaired, 
its bad effects sometimes compelled me to abandon it; and I have 
had the satisfaction of seeing emollients and acids produce a 
greater effect than before the sur-excitation, and restore a patient 
whom I should probably have lost, had I persisted in the exclu- 
sive employment of one or other of th^e methods.* 

If M. Broussais, has sometimes been exclusive in his theore- 
tical and practical views, it certainly is not in the passage just 
quoted, and which I have given literally, because it has not been 
properly appreciated. We observe with how much caution this 
author mentions even topical blood-letting; this was in conse- 
quence of his thinking, at the period of his writing the foregoing 
passage, that it was of little utility, or even prejudicial in typhus, 
when at all copiously practised. I believe, that at the present 
a less reserved in the employment of this measure, and 
that he. limits more the number of cases in which tonics may be 
used. I believe, that he does not attach any great importance 
to acidulous purgatives, or rather, I believe that he no longer re- 
- :o them, as he finds lavements sufficient, without their being 
attended with any of the disadvantages inseparable from purga- 
. which can only act upon the large intestine after they have 
more or less irritated the stomach and small intestine. There is 
also reason to believe, that he seldom attacks the apoplectic state 
by strong purgative enemata. Finally, how often do we see 
vital action exalted for an instant, when we pass from the use of 
tonics to that of emollients, only to sink more rapidly afterwards, 
even when we have recourse to them when vitality is almost ex- 
tinct? When, from the premature administration of tonics, the 
symptoms become meliorated, it is not true that we owe our 
success to the opposing of one irritation by another; for we can- 
not conceive that there can be two irritations at one time on 
the same membrane: we can only say, that certain internal in- 
flammations, like some external ones, are cured by the adminis- 
tration of tonics. t 

* Premier Examen, p. 177. 179. 

T See my Tieanse on Inflammation, Paris, 1524; and Thomson on Inflam- 
mation. 



TYPHUS FEVER. 313 

The remarks that have been made on the treatment of adyna- 
mic and ataxic fevers, render it unnecessary to enter into more 
ample details with regard to that of typhus, a subject as import- 
ant as it is difficult, and which requires new researches and ex- 
periments, directed not by hazard, but methodically, pursued in 
a manner conformable to the views which have been explained. 

If it be asked why blood-letting is of so little utility in ty- 
phus, while it is so generally beneficial in sporadic fevers of the 
gravest character, I announce that the fact is too true; but that 
we cannot account for it, and that we must know how to be ig- 
norant of what observation has not yet revealed. 

Dr. F. Ocks has just published on the diagnosis and treatment 
of typhus an incomplete compilation which may be advantage- 
ously consulted, although it possesses no merit in the depart- 
ment of pathological anatomy.* 

* Arti8 Medicas Principes de Curanda Febre Typhoide. Leipsick, 1830, 
in 8vo. 



40 



314 PHYSIOLOGICAL PYRKTOLOGY, 



CHAPTER VIII. 



Of Yellow Fever, 

We generally designate, by the name of yellow fever, a re- 
markable variety of the synochal fever, according to Currie, of 
the bilious fever according to William, of causus according to 
Towne, of inflammatory putrid fever according to Deveze, of 
putrid fever according to Macbride, of malignant fever accord- 
ing to Warren, of typhus according to Sauvages, of pestilential 
fever according to Chrisholm; finally, of ataxo-adynamic gastric 
fever according to Pinel. Is it not a remarkable fact, that this 
fever has been referred to all the known kinds of continued fever, 
with a single exception: viz.- the mucous fever? Is it essentially 
different from those which have been mentioned in the preceding 
chapters? or is it not in reality a variety of one of these? What 
is its origin, what are its causes, in what manner is it propagated? 
does it require a specific treatment? Is there any mode of pre- 
vention? Such are the questions which have been discussed with 
much warmth for many years. Certainly the solution of all these 
questions cannot be expected from me, and I do not hesitate to 
confess that I have never witnessed the disease; but since those 
physicians who have observed it, differ in their sentiments, we 
may be allowed to ask the truth in the midst of their discus- 
sions. 

On consulting with attention the works published on this fe- 
ver, we are struck with the perfect harmony that pervades them 
all in laying down the symptoms: on this account I shall confine 
myself to a general description of the phenomena of this dis- 
ease, without giving the particular history of every epidemic. 

The accession of the yellow fever is generally sudden: it is 
not, however, uncommon to observe precursory signs, which 
merit some attention: these are, generally, spontaneous lassitude, 



YELLOW FEVER. 315 

a state of languor, of general malaise, as at the commencement 
of many other diseases; but, often, to these symptoms are joined 
the following: pulse feeble, slow, profound, disappearing under 
the finger, or frequent, small, and intermittent; skin hot and dry, 
or cold and covered with a clammy moisture; features altered, 
mournful air, or feigned gaiety; lips pale and livid; tongue some- 
times red and dry, at other times, white, moist, and trembling; 
subsultus tendinum; slight tremors of the limbs. 

When these symptoms appear, during an epidemic yellow fe- 
ver, in a plethoric individual, whose brain or stomach has been 
irritated, there is reason to apprehend the invasion of the dis- 
ease. 

After the premonitory symptoms have continued a few hours 
or days, but more frequently without any premonition, the pa- 
tient complains of extreme prostration, inexpressible malaise, 
pain in the frontal and temporal regions, at the bottom of the 
orbits, in the loins, the vertebral column, the back of the neck, 
and the knees. Sometimes he is seized with a rigor, which is 
soon followed by a dry and pungent heat: the chilliness and 
heat, often alternate, as well as the paleness and redness of the 
face: sometimes the fever suddenly appears without having been 
preceded by a rigor. The face is most frequently red and ani- 
mated; the eyes sparkling, fixed, and suffused; the conjunctiva 
injected, the light is painful; sleep is either wanting, or is fre- 
quently interrupted; an air of astonishment and fright marks the 
countenance of the patient; he groans and weeps: the tongue, 
at first red, especially upon its borders, becomes dry, rough, and 
is covered, as well as the teeth and lips, with a yellowish, and 
afterwards a blackish deposite: all these parts are dry, as well as 
the nostrils and throat, which are affected with a sensation of 
itchiness; deglutition is impeded. The patient complains of 
heat, and acute pain in the epigastrium, which is tense, renitent, 
and painful on pressure, as well as the right hypochondrium; to 
the eructations and nausea, succeed violent vomitings, which 
adds to the epigastric pain, and is provoked by drinking; there 
is at first constipation, afterwards abundant alvine dejections, 
with pain in the abdomen. When the internal heat is conside- 
rable, the thirst becomes excessive, the extremities cold, the res- 
piration interrupted and laborious, the patient sighs profoundly; 
he experiences a sense of oppression, which may amount to or- 



316 PHYSIOLOGICAL PYRETOLOGY. 

thopnoea, and sometimes a sense of pain in the chest; the ex- 
pired air is then very hot, the urine is of a deep red colour; 
finally, the pulse is frequent, quick, and strong; it is sometimes 
full, especially in the afternoon, at which time the heat of the 
skin and the thirst are most strongly felt. 

Such are the symptoms of what is called the first period of 
yellow fever: none of them announce indubitably the existence 
of the disease; but sometimes one or more nasal, hemorrhages 
occur at this period of the disease, and the face begins to become 
yellow, symptoms which banish all doubt with regard to the dis- 
ease. This period, the duration of which is one or two, some- 
times three, rarely four, more commonly five days, constitutes, 
in a few cases, the whole disease. The symptoms gradually di- 
minish in intensity, the patient recovers his health, and it can- 
not be told whether the disease has been a gastric inflammatory 
fever or the yellow fever, unless icterus has been present. 

If the disease continues, the deposite which covers the tongue 
becomes more thick and black; the tongue is more dry, and the 
vomiting more frequent; the patient sometimes vomits white 
and acid mucosities, which set the teeth on edge, excoriate the 
throat, the tongue, and the lips; sometimes pure bile of a yel- 
low colour, and, at a later period, a black substance, mixed with 
abundant mucosities, resembling soot mixed with the white of 
en egg, beaten up with w T ater. This matter, according to some, 
exhales an hepatic, according to others, a sanguineous odour. 
Black blood is often vomited before the appearance of this black 
matter; the stomach is then so much irritated that it rejects eve- 
ry species of liquid, however violent may be the thirst When 
violent pains are felt in the epigastrium, in which the patient ex- 
periences a sense of extreme heat, the pains of the loins increase 
in intensity ; the alvine dejections are more frequent and abundant, 
formed of matters which are at first liquid and glairy, afterwards 
yellow, greenish, bloody, and, finally, blackish; in a word, si- 
milar to those which are ejected by the mouth : the urine is more 
and more deep, turbid, not sedimentous; sometimes a pellicle 
forms on its surface; it at last ceases to flow in cases which have 
become hopeless. The face becomes less red, often even pale, 
although the conjunctiva remains injected, and the eye brilliant: 
the features are profoundly altered, as in those abdominal dis- 
eases which are tending to the destruction of the organism; pain- 



YELLOW FEVER. 317 

ful dreams disturb the sleep when it occurs; the carotids beat 
with violence, yet the pulse frequently becomes more slow and 
unfrequcnt, or it resumes its natural standard. 

In the course of this second period, which is shorter in pro- 
portion as the preceding one has been longer, the yellow colour 
of the skin most frequently appears; lassitude, increased pros- 
tration, and a brighter redness of the eyes generally announce 
it. It commences on the face, the conjunctivas, below the mouth; 
it afterwards appears in the form of bands, on the neck, the 
chest, the thighs, and, according to M. Dalmas, along the course 
of the great arteries. The icterus is sometimes confined to the 
conjunctivae, even in mortal cases: it extends with the greater 
rapidity in proportion as the efforts of vomiting are more fre- 
quent and violent. The wounds made by venesection, open, and 
become black; a livid circle forms around the blistered surfaces. 
The yellow fever cannot now but be recognised; it is, however, 
no longer susceptible of being cured: the patient dies in the 
midst of these symptoms, or the disease may proceed with ra- 
pidity, and the third period be developed. 

Vomiting becomes more and more frequent; besides the black 
matter which has been mentioned, a blackish and very liquid 
blood oozes from the surface of the tongue, is discharged from 
the mouth, the nostrils, the anus, the vagina, and the urethra; 
the dejections are involuntary; the discharge of urine is com- 
pletely suppressed; the face is Hippocratic; muscular strength 
appears annihilated; yet there are subsultus tendinum, tremors, 
and convulsions, according to Valentin. Sensibility appears ex- 
tinct, respiration is slow and stertorous; the breath is cold, the 
pulse weak, small, unfrequent, intermittent; the whole body ex- 
hales an infectious odour; livid spots, petechias, ecchymosis, 
patches, and phlyctena?., of a gangrenous aspect, appear on diffe- 
rent parts of the body, and death is inevitable. In a small num- 
ber of cases, the parotids become inflamed; more rarely, still, 
we meet with carbuncles, anthrax, and buboes. 

The entire duration of the yellow fever is, in a few cases, 
from twelve to twenty-four hours, sometimes three days, but 
more frequently from four to eight days: death seldom occurs 
after the eighth day, unless the patient has experienced a re- 
lapse, generally a consequence of indigestion, or unless a very 
abundant hemorrhage suddenly supervenes. 



318 PHYSIOLOGICAL PYRETOLOGY. 

It may not be unprofitable to draw the attention of the re 
to the state of the intellectual faculties in the yellow fever. De- 
veze scarcely refers to it Valentin says, that the patient falls 
into comatose delirium or profound coma, when the vomiting 
ceases or becomes less frequent, and that delirium super- 
when the black vomit and deje : ti : ns appear. M. Dalrnas dwells 
much on the fright, which, from the first moment of accession, 
affects patients even of the most intrepid character; delirium is 
sometimes observed. In no grave disease, says M. Bah v. is 
the integrity of the intellectual faculties so completely prese: e 3 
as in this: he has seldom observed delirium. This proposition 
seems to be in exact accordance with facts. The fright men- 
tioned by Dalmas, is, perhaps, less a peculiar effect of the dis- 
ease than the natural dread of death in a malady so often fatal. 

In case of a fortunate termination of the : lis :-:. a e . : : aval sscence 
is rapid, and the strength soon re-established. 

Among all the symptoms which have been enumerated, we 
must first distinguish those which are observed in yellow fever, 
much more frequently than in any other disease; hterwards, those 
which are constantly observed in this fever. Amongst the first 
should be classed black vomit, alvine dejections of the same 
kind, hemorrhage, and icterus: among the second should be 
classed cephalalgy, the lumbar and epigastric pains, which are 
never wanting: after these, in point of frequency, we may men- 
tion icterus, vomiting, black dejections, and hemorrhage, which 
occur in the greater number of cases, but which are not con- 
stant. Yet icterus is seldom absent, and even when it does not 
make its appearance during life, :: generally manifests itself af- 
ter death. Although black vomit is not a constant symptom, 
vomiting almost always occurs. Hemorrhage is not alwavs ob- 
served, especially when death occurs during the first period of 
the :" isrj.se. Suppression of urine, is not more common in vel- 
low fever than in any other grave fever; it does not alwavs oc- 
cur, and its importance, as a diagnostic symptom, has been over- 
rated. 

It is unnecessary to enter upon an analysis of the other symp- 
toms of yellow fever, since they have been spoken of in the 
preceding chapters; but those which have been enumerated are 
deserving of minute attention. 

The source of the black matter, passed by vomiting and by 



YELLOW FEVER, 319 

stool, has been a matter of much disquisition: some have consi- 
dered it as derived from the liver, others from the spleen; but 
since it has never been found in these viscera, and has never 
been observed in the gall-bladder, nor in the biliary ducts, and 
since nothing has demonstrated its analogy to the bile, it should 
be regarded as a product of the secretory action of the mucous 
membrane of the stomach, especially as it has a striking resem- 
blance to what is passed in chronic inflammation of this organ, 
with degeneration of its parietes. The black blood, which has 
also been regarded as derived from the spleen or liver, appears 
to be only the effect of a hemorrhage from the gastro-intestinal 
mucous membrane. 

I have never observed the yellow fever; but I have seen a 
case of sporadic fever in every respect similar to it; the liver 
and spleen were sound; the stomach and intestines contained a 
black matter, and their vessels were very apparent. 

I have also found grumous blood in other subjects without the 
vessels of the intestines being more apparent; but the stomach 
had evidently been inflamed: there had been no yellowness of 
the surface. 

The proximate cause of the icterus has exercised the imagi- 
nation of physiologists of every period: the ancients attributed 
it to the presence of bile in the blood; chymical researches tend 
to prove that the colouring matter of the bile may be found in 
this fluid. In 1795, Joseph Frank attributed icterus, not to a 
resorption of bile, but to a sort of sanguineous extravasation, si- 
milar to what occurs in ecchymosis, produced by contusion. 
This opinion is not wanting in plausibility; but it would be in- 
correct to infer from this that the secretion of bile is not aug- 
mented in yellow fever. This secretion is evidently augmented 
when there is, what is not uncommon, vomiting and dejections 
of pure bile, of a yellow or greenish colour; besides, no one, as 
far as my knowledge extends, attributes icterus in acute disease, 
to the augmentation, but rather to the suspension of the biliary 
secretion, caused by irritation of the liver. Finally, it would 
be wrong to deny the connexion which subsists between icterus 
and irritation of this organ; for whether jaundice proceeds from 
the resorption of the bile or of one of its materials, or is occa- 
sioned by the suspension of the biliary secretion, it is not the 
less true that it is often a symptom of hepatitis, a fact from which 



320 PHYSIOLOGICAL PYRETOLOGY. 

we may reason by analogy, that it announces irritation, at least 
of a sympathetic character, of the liver in yellow fever. Should 
the accusation of inconstancy be urged against me, as asserting 
that there is at one time augmentation, at another, suspension of 
the biliary secretion in this fever; it will be a sufficient answer 
that the elaboration of bile may be suspended, at the same time 
that the portion of this secretion already formed, flows into the 
stomach, when this organ and the duodenum are irritated. It 
is doubtless in this manner that icterus progresses in proportion 
to the efforts at vomiting. 

I cannot but think that in the vomiting, of whatever charac- 
ter it may be, and in the icterus, we must recognise two symp- 
toms of irritation of the stomach and liver. The pain extending 
from the epigastrium to the right hypochondrium, the tension 
and renitence of these two regions, and the increase of pain ex- 
cited by pressure upon either of them, render the truth incon- 
testable. 

Cephalalgy, the pain felt in the bottom of the orbits, the red- 
ness of the conjunctivae, the fixedness of the looks, are so many 
unequivocal signs of irritation of the meninges. The integrity 
of the intellectual faculties in the greater number of cases appears 
to show that the irritation of these membranes, of whatever na- 
ture it may be, propagates itself slowly to the brain. Are the 
pains of the loins and posterior part of the neck purely sympa- 
thetic, or do they indicate that the spinal marrow or its termina- 
tion participates in the morbid state? It is difficult to believe 
that a part may become the seat of pain, or that a pain may be 
referred to a certain part/without there being lesion of this part; 
but it remains to determine w r hether this lesion be secondary or 
primitive: pathological -anatomy must resolve this question. 

Do the symptoms mentioned, authorize us to consider the dis- 
ease which they characterize, as an essential fever different from 
all others? I think not: 1st, because the black vomit, even 
though it always occurred, is but a symptom, and the existence 
of a special phenomenon is not sufficient to constitute a disease 
essentially different from every other disease: 2ndly, because the 
black vomit depends upon a lesion of the digestive organs, which 
should not be studied in its symptoms alone, to acquire an exact 
idea of it: 3rdly, because icterus is one of the phenomena most 
remote from the proximate cause of the yellow fever, since it 



YELLOW FEVER. 321 

frequently does not manifest itself until after death: is it not sin- 
gular that physicians who reproach us with seeking in the red 
colour of the mucous membranes, the nature of several fevers, 
should think they find the most important phenomena of yellow 
fever in the citron colour of the skin? 4thly, because the colour 
of the matters passed by the mouth, or by the anus, or that of 
the skin, cannot distinguish diseases: otherwise it would be ne- 
cessary to recognise red fever, green vomit, white fever, yellow 
vomit. What should we say of the physician who, at the pre- 
sent day, should assign the last denomination to gastric fever, 
the first to inflammatory fever, the second to cholera, and the 
third to mucous fever? 

What are we to think of the remission which it is said is re- 
marked in most subjects, during the course of the yellow fever? 
that it is not sufficiently constant to characterize in a special man- 
ner this disease; because it is not always found in the history of 
the particular cases reported by the authors who assign to it so 
prominent a place in their general descriptions of the epidemic. 
Analogous remissions have been observed in many fevers which 
have not presented the symptoms said to be peculiar to yellow 
fever. 

To exclude the study of symptoms from an investigation of 
the seat of diseases would be an absurdity. The proper course 
is to compare them with the traces found on dissection. 

We shall commence, by saying with M. Bally, that there are 
bodies which present to the anatomist no traces of disease, and 
we shall add in accordance with this judicious observer, lhat this 
peculiarity is observed, especially in those who die from the 
first to the third day, and on whom the disease has not had time 
to impress its anatomical character.* 

Whether icterus has manifested itself before or after death, the 
skin is of a citron colour, and covered with violet, brownish 
patches, particularly on the parts of the body which are lowest 
in position. The bodies pass rapidly into putrefaction, a circum- 
stance which obliges us to open them as soon as possible after 
death. This necessity of proceeding with rapidity, has the ad- 
vantage of making us acquainted with the state of the organs 
before any alterations, except those which are the effect of the 

* Du Typhus de Amerique ou Fievre jaune. Paris, 1814, p. 202. 
41 



322 PHYSIOLOGICAL PYRETOLOGY. 

disease, can establish themselves: but at the same time, it in- 
creases the danger of these researches, so painful, and so honour- 
able to him who applies himself to them with assiduity, and with 
all the attention they deserve. 

When an incision is made into the skin, we find the whole 
cellular tissue infiltrated with a yellowish serosity, more or less 
abundant. The muscles are sometimes red and renitent, some- 
times pale and soft. M. Rochoux says, that he has found blood 
extravasated into the intermuscular cellular tissue.* 

It is in the abdomen that we find alterations the best charac- 
terized, and the most constant. When this cavity is opened, a 
fetid odour of a peculiar nature is exhaled from it; after which, 
according to Deveze, we can neither find definition nor compa- 
rison, t 

All physicians, who have written upon the subject of yellow 
fever, agree in saying, that in the greater number of cases, the 
mucous membrane of the stomach is of a more or less bright 
red, or of a brownish red, sometimes ulcerated, gangrenous, and 
destroyed in part of its extent, especially towards the pylorus. 
These traces of inflammation are not less frequent in the duode- 
num; they are more rare or less prominent in the rest of the di- 
gestive canal, and especially in the great intestine. It appears 
that gangrene of the gastro-intestinal mucous membrane is not 
so common as many others have considered it. 

The stomach and intestines, but especially the first of these 
organs, often contain a considerable quantity of the black mat- 
ter, even when it has not been discharged during life. With 
this matter, clots of blood are often found mixed. In a few 
cases, instead of black matter, we find pure blood. INI. Cher- 
vin,J who has often tasted these different substances, has per- 
ceived in them a decided taste of blood, when they presented 

* Recherches sur la Fievre jaune. Paris, 1822, in 8vo. p. 155. 

| Dissertation sur la Fievre jaune. Paris, p. 83. 

% Until the publication of the wort which has been announced from the 
pen of this distinguished physician, the following works may be consulted: 
Examen des Principes de l'Administration en matiere sanitaire. Paris, 1827, 
in 8vo. — Examen critique des Pretendues preuves de Contagion de la Fievre 
jaune, observee in Espagne. Paris, 1828, in 8vo. — De 1'Opinion des Medicins 
Americains sur la Contagion ou non-Contagion de la Fievre jaune. Pari?, 
1829, in 8vo. — Examen des Opinion de M. Lassis, concernant la Fievre 
Jaune, qui a regne a Gibraltar. Paris, 1829, in 8vo.— Examen des Opinions 



YELLOW FEVER. 323 

most of the exterior qualities of this fluid; at other times, they 
have appeared to him bitter and acrid, having something corro- 
sive in their taste: this was particularly the case with the red- 
dish matters; none of those substances are offensive, like the 
gas, when the body is examined a short time after death; but 
when the examination is delayed thirty-six or forty-eight hours, 
the fetor is excessive, evidently, in consequence of the com- 
mencement of putrefaction: this is by no means an essential cha- 
racter of the disease, although it has been thought so by many 
physicians. 

The mucous membrane of the gall-bladder has been found 
thickened, and sometimes of a brownish red. The gall-bladder 
is often retracted, and sometimes contains black and pitchy bile, 
which, according to Deveze, is by no means caustic. 

The liver is almost always large, gorged with blood, soft, yel- 
low in its interior, covered on its surface with slate-coloured 
patches: it seldom presents traces of suppuration. The spleen 
generally presents no remarkable change. The kidneys are 
often redder than in their natural state, or, at least, gorged with 
blood. M. Rochoux found them inflamed in one-fourth of the 
bodies opened by him at Martinique. The bladder is often con- 
tracted, and its mucous membrane red throughout almost its 
whole extent: it contains a variable quantity of urine, often 
brown and sanguineous, especially when the quantity is small. 

After these lesions, in point of frequency are those of the en- 
cephalon: the lesion of this organ generally consists in nothing 
more than the presence of a certain quantity of yellowish sero- 
sity, sometimes sanguineous, on the hemispheres or in the ven- 
tricles: the vessels are often gorged with blood as well as the si- 
nuses, which contain a yellowish gelatinous matter, in point of 
colour resembling the serosity which is found in the cellular 
tissue: sometimes there are unequivocal traces of inflammation 
in the arachnoid. The cerebral substance has been examined 
with too little care, to permit any positive assertion with regard 
to its condition. It has been said to be occasionally possessed 
of but little consistency: some have asserted that it was more 
compact than in health. 

de M. Castel touchant la pretendue Contagion de la Fievre jaune. Paris, 
1830, in 8vo. — Lettre a M. Monfalcon sur la Fievre jaune, qui a regiae a 
Gibraltar en 1828. Paris, 1830, in 8vo. 



324 PHYSIOLOGICAL PYRETOLOGY. 

M. Dalmas has judiciously remarked, that lesions of the en- 
cephalon and its membranes are principally found in those indi- 
viduals whose intellectual functions have been remarkably dis- 
turbed. 

He says that .he has opened subjects, in which he found no 
other morbid traces than those of congestion of the brain, and 
that, at other times, the chest alone presented traces of disease.* 

It is not uncommon to find the lungs gorged with black blood, 
which flows out when an incision is made into these organs: they 
are covered externally with livid spots; their substance was found 
by M. Bally contracted, black, and as it were burnt, in a single case. 
Red, violet, and livid patches are not unfrequently found in the 
lungs, as well as adhesions formed by a layer of a yellow, gelati- 
niform substance. The pericardium often contains an analogous 
substance, and sometimes a bloody serosity. M. Bally has almost 
always found in the heart, a yellow transparent clot of considera- 
ble size, extending sometimes into the aorta, and resembling fine 
jelly or amber. Persons who have never examined bodies have 
considered this appearance as very peculiar. 

I must add what has been published upon this subject since 
the first edition of this work, being an account of the principal 
results of post mortem examinations made at Barcelona in 1821, 
by MM. Bally, Francois, and Pariset. I shall quote literally 
from their report. 

The skin, almost always of a citron yellow, was often marked 
with brownish patches on the eyelids, the forehead, the face and 
extremities: patches which must not be confounded with post 
mortem ecchymosis. The petechias had not disappeared, and 
their colour was but little changed: they continued of a rose co- 
lour, inclining slightly to brown: they were particularly obser- 
vable on the abdominal extremities, on the face, the neck and 
the arms. The arachnoid membrane was seldom opaque; the 
lateral ventricles contained a small quantity of serosity. In many 
of the bodies several ounces of blood were found extravasated 
between the cranium and dura mater, or between the two layers 
of the arachnoid membrane, sometimes also at the base of the 
cranium. The pons varolii and the cauda equina, which had been 
considered as somewhat atrophied in our post mortem examina- 

* Recherches Historiques et Medicales sur la Fievre jaune. Paris, 1822, 
in 8vo. p, 17. 



i 



YELLOW FEVER. 325 

lions In St. Domingo, presented no peculiar appearance; the lat- 
ter appeared even enlarged in one of the hodies. The termina- 
tion of the spinal marrow was always found bathed in a copious 
collection of yellowish, limpid, serous matter, varying in weight 
from two drams to two ounces and a half. There was no red- 
ness of the dura mater, no opacity of the arachnoid, no inflam- 
mation or thickening of the pia mater of the spinal marrow. In 
one subject a reddish tint was observed on the inferior extremity 
of the latter membrane. The cauda equina, which was bathed 
and in some sort macerated in the fluid, was perhaps a little 
softer than usual; perhaps, likewise, the sacral nerves presented 
a slight degree of redness. An effusion of blood was often ob- 
served at the inferior part of the dorsal and superior part of the 
lumbar region, between the bodies of the vertebrae and the dura 
mater. This collection of blood was sometimes found in the 
sack formed by the arachnoid, always in the same region and at 
the same height. The pleura, the bronchial mucous membrane, 
the lungs and the pericardium sometimes presented traces of in- 
flammation, or serosity, or even blood was found in them. The 
fibro-albuminous clot, yellowish and transparent, was always 
found in the cavities, and particularly in the right ventricles of 
the heart. When there had been an oozing of blood in the 
moift, the blood sometimes appeared to be derived from the 
lateral part, sometimes from the gums and tongue only, some- 
times from the palate, and occasionally from the whole mem- 
brane. The stomach, in a few cases, presented no inflammation; 
frequently, however, redness, injection, and apparent traces of 
ecchymosis appeared on the mucous membrane. These inflam- 
mations, generally superficial, reddish, sometimes inclined to 
violet, were disseminated on the internal surface of the stomach, 
and particularly towards its orifices. They sometimes appeared 
in small, round, distinct spots; sometimes in oblong patches, 
which were confluent and occupied a larger surface. In other 
cases, the whole extent of the internal membrane was inflamed. 
If the inflammation existed in the highest stage of intensity, 
brownish points, of greater or less extent, were discovered: 
these points were easily raised and detached by the knife, and 
the position of the mucous membrane was thus reduced to a 
pulp. The small intestines generally participated in the state of 
the stomach: it even appeared, sometimes, that the inflammation 



326 PHYSIOLOGICAL PYRETOLOGY. 

of the former was of a more serious character. The traces of 
inflammation were less prominent in proportion as they ap- 
proached the termination of the digestive canal, and they were 
seldom observed in the large intestines. Liquid blood of a nau- 
seous odour, having the taste of ordinary blood, was found in the 
stomachs of one-eighth of the subjects, and sometimes complete- 
ly "filled this organ. When the inflammation of the internal 
membrane was more intense and more extended, the stomach 
contained a kind of grayish pulp of little consistency, resembling 
flax-seed meal mixed with water, and having no resemblance to 
blood, or to the black matter, and never found in the intestines. 
In seven-tenths of the subjects, a brownish fluid was found, which 
floated a substance more or less abundant, resembling the grounds 
of coffee, or soot mixed with water. This substance, which was 
heavier than the fluid containing it, was generally precipitated; 
the fluid was sometimes of a very deep colour, occasionally as 
black as ink. The brownish matter frequently extended as far 
as the rectum: in proportion to its distance from the stomach, it 
became black and thick. In the superior portion of the small 
intestine it generally exhaled an odour, which was not very 
powerful, was rather nauseous, but by no means very offensive. 
The liver appeared somewhat larger than usual: it always pre- 
sented the yellow colour of rhubarb. The peritoneum rarely 
presented traces of inflammation, which were still less frequent- 
ly observed in the biliary and urinary bladders.* 

The same alterations were observed in the course of the same 
epidemic by M. Adouard: this coincidence in the reports of phy- 
sicians, whose observations were made separately, constitutes a 
presumption in favour of their correctness.! 

M. Thomas, secretary of the Medical Society of New Orleans, 
reports that he examined ten bodies during the epidemic yellow 
fever which prevailed in 1822 at New Orleans, and that he dis- 
covered in most of them a considerable effusion of black blood 
in the spinal canal and the adjoining muscles, a rosy colour of 
the membranes of the spinal marrow, and unequivocal traces of 
inflammation of the stomach.^ 

* Historique Medicale de la Fievre jaune observee en Espagne et parti- 
culierement en Catalogne en 1821. Paris, 1823, in 8vo. p. 339, 359. 

f Relation Historique et Medicale de la Fievre jaune qui a regne a Bar- 
celone en 1821. Paris, 1822, in 8vo. 

\ Essai sur la Fievre jaune d'Amerique. Paris, 1823, in 8vo. p. 130. 



YELLOW FEVER. 327 

In reviewing; the organic alterations found after yellow fever, 
we observe that there are in almost every case, traces, often deep 
and extended, of inflammation of the stomach. The large in- 
testines participate less in the inflammatory state than in other 
fevers. The liver, free from any remarkable lesion, was not en- 
tirely sound, except in a limited number of cases. If we may 
credit M. Rochoux, the gall-bladder was always found inflamed 
at Martinique. The kidneys and bladder are not less inflamed 
than in other acute diseases in which there is suppression and 
retention of urine. The lungs, in general, possess few traces of 
inflammation; finally, in a few cases traces of spinal or cerebral 
arachnitis are discovered. 

These results demonstrate that inflammation of the stomach is 
the principal affection in yellow fever, and favour the presump- 
tion that the membranes of the spinal marrow frequently parti- 
cipate in the inflammation. As long as the careful examination 
of the spinal marrow shall be neglected in our climates, in all the 
subjects who die of acute gastro-enteritis, as long as we shall be 
wanting in positive information with regard to the signs of spi- 
nal arachnitis, so long will it be irrational to affirm that inflam- 
mation of the meninges of the spinal marrow is the distinctive 
character of yellow fever. 

But a small number of post mortem examinations have been 
made in epidemic yellow fever: authors have generally confined 
themselves to an exposition of general results, or to a very limit- 
ed number of observations. This important subject is far from 
being exhausted: until we are in possession of the results of as 
great a number of post mortem examinations in the present fever 
as we possess in other fevers, there will be reason to fear that the 
exceptions will be erected into a rule, as was frequently the case 
when pathological anatomy was in its infancy. I must take the 
science at the point at which I find it, and, admitting the correct- 
ness of the writers who have seen the yellow fever, I shall at- 
tempt to investigate the seat and nature of this disease. 

M. Tommasini appears to me to have been the first who pub- 
lished sound ideas of the nature and seat of yellow fever; he first 
attempted to prove that it was only the highest degree of bilious 
fever. Adopting the opinion of Pringle, Lind, Mosely, Pinel, 
and M. Rubini, he remarks that these fevers have the same symp- 
toms, differing only in degree; that the same organic lesions are 



328 PHYSIOLOGICAL PYRETOLOGT. 

found in them, and that the causes and circumstances which pro- 
duce them, or favour their development are the same. " I do 
not know."' he adds. " what should prevent our classing yellow 
fever among the phlegmasia^, since we rank with them perip- 
neumony. which is a general pyrexia, conjoined with inflam- 
mation of the lungs, as the yellow fever is a general pyrexia con- 
joined with inflammation of the liver, and the internal surface 
of the stomach and intestines.* 

M. Bally has not adopted the opinion of Pinel. and he appears 
not to have duly appreciated that of M. Tommasini: in speaking 
of the yellow fever, he remarks. '"'This typhus might, perhaps, 
have found a more suitable place in the sixth order, together 
with the plague: this order might then have been divided into 
two genera, or even more, if it were thought proper to assign a 
place in it to the Sudor Anglicus and the typhus of hospitals. n 
This arrangement would be a near approach to that of Sauvages, 
who makes yellow fever the seventh of the nine species of his 
genus typhus. M. Bally did not devote his attention to an in- 
vestigation of the seat of the yellow fever of 1S14, although he 
approved of the opinion of M. Bancroft, who stated that the 
greater portion of fatal cases arose from irreparable injuries sus- 
tained by the brain and stomach. 

During his residence in St. Domingo, M. Francois was per- 
suaded that the seat of yellow fever was in the medulla oblon- 
gata or in the cerebellum, which he had always found either 
smaller or more friable than in the ordinary state. He should 
have stated definitely which of these two parts had been found 
diminished in size, for it could not be indifferently one or the 
other of them. M. Bally remarked that in one of the bodies 
which he opened, the medulla oblongata, where it penetrates 
into the spinal canal, was sensibly smaller than in the normal 
state, and appeared, as it were, atrophied: there was a considera- 
ble space between the dura mater and the arachnoid membrane, 
so that the finger could pass freely between them: there was ob- 
served some serosity slightly tinged with blood. M. Bally far- 
ther remarked, that in the body of an officer, concerning whose 
disease no information could be obtained, but whose skin was 

* Recherches Pathologiques sur la Fievre de la Livoume de 1504; sur la 
Fievre janme de Ameriqne et =ur les Maladies qui leur sont analogues; tra- 
duites de L'ltatiea Paris, 1512. 



YELLOW FEVER* 329 

deeply tinged with yellow, the medulla oblongata appeared 
shrunk, and did not fill the occipital foramen. 

MM. Bally and Francois no longer regard the medulla oblon- 
gata as the seat of yellow fever, but rather the cauda equina; and 
M. Pariset accords with them in opinion. By what strange fa- 
tality is it, that the attention of these physicians has been fixed 
alternately on the extremities of the spinal marrow, instead of 
being directed to the stomach, which presented evident traces of 
inflammation in the nineteen bodies which were opened at Bar- 
celona? Because the arachnoid membrane of the spinal mar- 
row was not found red and opaque, they declined considering it 
as inflamed ; while, at the same time, they pretended that the 
gastritis, the traces of which they have described with so much 
care, was consecutive to the affection of the cauda equina. 

An examination of the symptoms of yellow fever, and of its 
pathological anatomy, although the researches in the latter have 
been limited, has induced M. Dubreuil to regard the disease as 
a gastro-enteritis, ataxic, or adynamic, arising from a dele- 
terious cause, or a virus sui generis,* not as a well developed 
phlegmasia, but rather as a malignant inflammation. The liver 
appeared to him to suffer lesion as a secretory organ, not as a 
glandular organ. I have already expressed my opinion on the 
impossibility of admitting inflammations, which vary in any 
other manner than as it respects their seat, their intensity, and 
their sequelae. M. Dubreuil always regards gastro-enteritis as 
the primitive lesion in yellow fever. 

M. Broussais thinks that this fever is but a gastro-enteritis, 
aggravated by atmospherical heat, which occasions it to pursue 
its progress with an activity unknown in our more temperate 
climates. t This appears to be the only admissible opinion in the 
present state of the science: we should only add, that the ence- 
phalon is generally less seriously affected in this disease than in 
most ataxic fevers, since the intellectual functions preserve their 
integrity until a short time before death. 

The jaundice depends, according to M. Broussais, upon in- 
flammation of the small intestines, and especially of the duode- 
num, which augments the secretion of bile, and at the same time 

* Memoire sur la Fievre jaune, insere dans le Journ. Univ. des Sc. Med. 
viii. p. 317. 
f Annales de la Medicine Physiologique, i. p. 460. 

42 



330 PHYSIOLOGICAL PTRETOLOGY. 

c - z ■■: ses the disgorgement of the liver, by determining the con- 

stricticn cf the due": us chcledochus. Wimouc resorting tc this 



tv. 



poured into the duodenum, until the gall-bladder is empty, or 

nearly so. The I:.::er is seldom found hlled after the yeho'.v f-- 
ver. Should the remarks of M. Rcchoux, with regard to the 

inflammation of the biliary bladder ar.d ducts, be ecmermed by 

cases, must henceforth be sought, net on the surface of the 
liver, but in the biliary du:t. 

Is it not the fact, that under the name of yell:"' fever, many 
diseases of different seats have been designated, having this com- 
mon character, that they are inflammatory and give rise to icte- 
rus: This v.- a s the crimen :f Urban: (Teste. v.beo. -vhile in An- 
dalusia, had observed acute gastro-enteritis with jaundice, when 
there v.- as u: reason to sospet: that the yellf-v fever had been 



hether the veflow fever is at 



ne- 
on* 
dis 





a summary 

'■ Snail ve 


Ma 


rtinique. or 


:rt 


td intc tnis 



Tie multitude of publications which have appeare 

.5. pro^ es the: thev are net susceptible :: a 



c u e 



In a small work published in Philadelphia" in 1794, Deveze 

had not been imported by vessels coming from St. Domingo. 
The greater part cf the physicians cf the United States, and of 
xhe Caribjbee islands, ultimately adapted this opinion. 

M. Ballv advocates the opinion that it is imported, an: is con- 
tagiens. at least in many oases: and hev.-;* c: .::::. tee: .u 

* Recherches e: O:--:::: ;u: le= Causes e: le= Efets de la Maladie 
Epideniicue qui a rerne a Philadelphia, en 1793, Philadelphia, 1794.. 



YELLOW FEVER. 331 

opinion during his residence at Barcelona. Many physicians of 
that town believe, on the contrary, that it is not contagious, al- 
though some among them do not deny its importation. 

According to Urbain Coste, the most current opinion at the 
present day, among the physicians of Andalusia, who have seen 
the disease, and who have intelligence and independence enough 
to form an opinion for themselves, is that the importation of the 
disease is a demonstrated fact, but without any reference to con- 
tagion. The constant coincidence of the appearance of this fe- 
ver with the arrival of vessels from the colonies, and the well 
known fact, that the disease first appears among those who have 
visited the ships, have assisted in the discharge of the cargo, and 
the opening of the bales, have given rise to the opinion that the 
air of the yellow fever is imported by the vessel. Contagion 
does not, with these physicians, imply the idea of a specific vi- 
rus, but only that of a poisoning by a gas. Its propagation 
only signifies the reproduction of this same poisoning in the per- 
sons of healthy individuals, by means of the importation of the 
air corrupted by the sick, within a sphere, the limits of which 
it is impossible to determine. 

This exposition of the opinion of the physicians of Andalu- 
sia, with regard to a disease which they have so often observed, 
I regard as the more valuable, as it was transmitted to me by a 
man distinguished for veracity, in whose premature death sci- 
ence has sustained a heavy loss. * 

All the arguments advanced on both sides of the question of 
the contagion, and importation of yellow fever, have been col- 
lected with care, in a work whose authors unfortunately speak 
like myself, without personal observation, t It does not belong 
to me to untie, much less to cut this Gordian knot. However, 
the remarks which have been made on the subject of the propa- 
gation of typhus, and the sanitary measures which it demands, 
appear to me applicable to the yellow fever, and I shall only add 
a few reflections.^: 

* Voy. ses Observations Medicales sur la Campagne d'Espagne, en 1823. 
Paris, 1825, in 8vo. 

f Recherches sur la Contagion de la Fievre jaune, par J. D. Bouneau et 
E. Sulpicy. Paris, 1823, in 8vo. 

| With regard to the measures to be taken to prevent its importation, a 
small work by M. Keraudren may be consulted, entitled, Projet de Regie- 



332 PHYSIOLOGICAL PYRETOLOGY. 

The first question which present? itself, and perhape the only 

decisive one. is — Does the yellow fever prcpegete itself from an 
individual affected by it, to another in health? or, in other and 
more precise terms, does an individual approaching another af- 
fected with the yellow fever, become diseased in the same man- 
ner? The only answer to this question which appears conform- 
able to facts, is an affirmative one: for, 1st, if an individual enter 
the eharnber of a person affected with the yellow fever, he is 
frequently seized with the disease in a short time, although he 
may not have touched the patient: 2dly, the disease commences 
in some point of a town, and only spreads gradually to other 
districts, at last, however, invading those places which are most 
advantageously situated. I know not whether these facts are 
false, or whether they have been badly observed: but until their 
inaccuracy has been demonstrated, we are not permitted to re- 
ject the consequence naturally flowing from them. We are, 
moreover, indebted to M. Keraudren for the publication of im- 
portant facts, collected on board public ships, which tend to es- 
tablish the contagious nature of the yellow fever. 

Does the yellow fever propagate itself beyond the limits of the 
town in which it prevails. This point is of a more uncertain 
character: it even appears that it may be answered in the nega- 
tive; for the disease did not extend into the villages in the neigh- 
bourhood of Barcelona, comprised within the limits of the cordon, 
although patients went thither to die.* It results from this last 
circumstance, which is universally acknowledged, and which ac- 
cords with a multitude of other facts, that the yellow fever is 
less capable than the typhus of spreading to a distance. But ex- 
perience has not yet decided, whether an army, suffering from 
the ravages of this fever, can transport it to a neighbouring na- 
tion, the season and locality being favourable: this supposition, if 
we reflect on the propagation of typhus, does not appear absurd, 
and the occurrence of so dreadful a calamity, should therefore be 
guarded against. Whatever be the opinion entertained with re- 
gard to the manner in which the disease communicates itself, it 
is important to investigate the circumstances which favour its de- 
velopment and propagation. 

ment ayant pour objet de prevenir l'lntroduction par mer des Maladies con- 
tagieuses. Paris, in Svo. 

r Rapport de la Commission Medicale envoyee a Barcelona, Paris, 1822. 



YELLOW FEVER. 333 

A physician, who has done honour to the name of France in 
the United States, proposes to determine by experiment, whe- 
ther this disease can be communicated.* The indefatigable zeal 
and honourable perseverance of Deveze, arc deserving of praise; 
but, it may be asked, — do his experiments, although made where 
the yellow fever was not prevailing, conduct to decisive results? 
If the disease was not developed in the individuals who were ex- 
posed to it, is it rational to conclude, that it never communicates 
itself? If the disease did communicate itself, should we then 
have a certain means of recognising the organ which had re- 
ceived and introduced into the system the agent of transmis- 
sion? 

A consolatory fact, for the northern countries of Europe is, 
that this fever has not appeared farther north than the 45° of lati- 
tude.! It has been observed a great number of times since the 
year 16S4, in Brasil, Peru, Guiana, Darien, New Grenada, the 
Antilles, St. Domingo, Mexico, Havana, Louisiana, Florida, the 
United States, the Canaries, Africa, Spain, once in Leghorn in 
1S04, and never in France except in the Lazarets. 

In many parts of America, it prevails more or less during the 
whole year, but especially during the months, when the heat is 
most intense, and most permanent. Beyond the limits of the 
tropics, it ceases immediately on the approach of the cold season, 

* Meraoire au Roi en son Conseil des Ministres et aux Chambers. Paris, 
1821. 

f The malignant fever of Rochefort, described by Chirac, and which was 
mentioned in the preceding- chapter, was not the yellow fever; Chirac, far 
from considering it contagious, as he is said to have done in an historical mo- 
nograph of the yellow fever, strongly censured those who believed it such. 
The epidemic which desolated Brest in 1747, was not the yellow fever. It is 
painful to think, that measures of so great importance should be taken in con- 
sequence of assertions so lightly made : but the utility of these measures seems 
justified by the following fact. When Admiral Villaret returned to Brest, 
with the ship3 which had transported to St. Domingo the army of General 
Leclerc, a custom-house officer who had been placed on board a ship, in which 
the mortality had been great, contracted a disease, which proved fatal in less 
than forty hours. Duret, a distinguished surgeon of the navy, visited the 
patient and recognised the yellow fever. Two other persons, not belonging 
to the armament, but who had communicated with it, were also attacked; 
one died on the fifth day, and the other recovered. Sanitary measures were 
adopted, and the disease did not extend. (Keraudren, Projet de Reglement, 
etc.) 






334 PHYSIOLOGICAL PYRETOLOGY. 

It never appears when the thermometer is below the fifteenth or 
sixteenth degree of Reaumur. In America, it seldom attacks the 
Creoles, the negroes, and the mulattoes; its victims are generally 
Europeans, who have recently arrived. The same individual 
is seldom affected twice with this fever; but a native, after a long 
absence, is liable to contract it upon his return. The same is the 
case with Europeans, who, after having suffered from this dis- 
ease, leave the Caribbee islands, and return after an indefinite 
period. In Europe its ravages have not been confined to any 
particular class of inhabitants. 

The places most liable to the ravages of the yellow fever, are 
populous cities, situated upon the sea-coast, which is more or less 
damp. It rarely extends more than ten leagues from the sea; 
when it spreads to a greater distance, it is along a considerable 
river. It does not appear that it has ever crossed a chain of 
mountains, although it is said to have prevailed in some elevated 
parts of Spain. In America it has never been observed in ele- 
vated situations: it is generally in low grounds that it prevails. 
Hence, it may be concluded, that humidity favours its develop- 
ment It cannot be doubted, that marsh miasmata contribute to 
its origin; but these cannot be the sole cause, since there are not 
marshes in all the places in which it is observed. 

The yellow fever is said to have sometimes appeared aboard a 
vessel without its having had any communication with the land. 
This does not appear to have occurred except within the tropics; 
but the disease has continued after the vessel has arrived in a 
more temperate climate. 

Westerly and southern winds appear to favour it either at sea 
or on land. 

If the long continuance of a low temperature arrests the ra- 
vages of the yellow fever, a momentary current of fresh air is 
the condition most favourable to its development: thus, it is ob- 
served to attack a greater number of persons after a rain which 
has cooled the atmosphere. By a totally opposite action, inso- 
lation determines it very frequently, and in such cases, there is 
reason to believe that irritation of the meninges may precede 
the gastritis, which, however, declares itself in a short time. 

Like all other fevers, it manifests itself under the influence of 
depressing moral affections, nostalgia, fatigue, excess in study, 
in venery, in food and drink. Conjoined with heat and the sup- 



YELLOW FEVER. 335 

pression of cuticular action, these excesses are certainly the most 
powerful causes of the yellow fever: some of these causes act by 
exalting the sensibility, that is, the cerebral action, and others 
by exciting the organs of digestion. Under these circumstances, 
cold applied to the skin, a moral affection, or fatigue, however 
slight, may develop the yellow fever. 

Its victims are particularly adults, the male sex, individuals 
of ample chest and vigorous heart, and of excitable nervous sys- 
tem. Women are less subject to it than infants, and it still more 
rarely attacks old men. 

None of the causes which have been pointed out, are suffi- 
cient to produce yellow fever, even of sporadic character. Their 
concurrence is essential to its epidemic prevalence, and is the 
cause of its existence in many countries without its having been 
imported. It is unnecessary to remark, that the most decided 
partisans of its importation declare, that it cannot occur, unless 
there exist causes favourable to the introduction of the miasm. 
This consideration is of great importance to a determination of the 
sanitary measures which should be enacted, with a view to the 
preservation of towns, situated at a great distance from each 
other. We may add, that, acccording to M. Bally, the emana- 
tions of the yellow fever are not so heavy, or so susceptible of 
importation as those of the plague, and that they seldom resist 
atmospheric changes. 

The yellow fever prevailed in 1823, in Port du Passage, in 
Spain, near St. Sebastian, and, according to M. E. L. Jourdain, 
one of the causes of this fever was the pernicious air which had 
been long confined in the brig Donosteria. This, together with 
other causes, such as elevated temperature, humidity, the crowd- 
ing together of people, the situation of the place, developed the 
yellow fever, a disease which, by its nature, is a true gastroenteri- 
tis, presenting a peculiar physiognomy. It was not contagious 
in this town, and persons who were attacked by the disease, and 
who were carried to the environs of the town, and died, did not 
communicate it. Eighty-live individuals were attacked: of 
these, twenty were cured before the establishment of the cor- 
don: of the sixty-five who remained at Port du Passage, twen- 
ty-seven were men, and thirty-eight women. Twenty-four 
died, of whom thirteen were men, and eleven women, to these 
must be added a custom-house officer, five carpenters, a huck- 



336 PHYSIOLOGICAL PYRETOLOGY. 

ster, and a physician, who, after having attended the sick, re- 
tired in good health to the neighbourhood of the town, where he 
was taken sick, and died; and finally, two persons, man and 
wife, who died at Loyola, whither they had gone in health, 
but after having visited the ship. 

Ten or twelve days after the departure of the brig from Ha- 
vana, one of the crew who had eaten fruit, and drunk brandy in 
large quantities, died: a short time after his death, much foam 
was discharged from his mouth: there had been no other sick 
persons on board. 

Two bodies were opened at Port du Passage. One was a mer- 
chant, forty-two years of age, and of sanguine temperament. 
After forty-four hours of sickness he was affected with horrid 
convulsions, and icterus, had dejections of black blood, and 
was delirious. Blood-letting had been practised with the inter- 
nal exhibition of demulcents, and the application of sinapisms. 
A considerable effusion of bloody serosity was found between 
the lobes of the brain, the vessels of which were greatly in- 
jected; the mucous membrane of the oesophagus and small intes- 
tines was inflamed: clots of blood were found in the right auri- 
cle of the heart: there was black matter in the stomach, the liver 
was large, and the gall-bladder empty. 

The other body, which was examined, was that of a woman, 
aged twenty-three, of sanguine temperament, who died of a sick- 
ness of three days. There had been very decided icterus, 
black vomit, very copious black dejections, nasal hemorrhage, 
delirium and hiccough. Eight leeches only had been applied; de- 
mulcents and sinapisms had been prescribed. A considerable 
effusion of bloody serosity was found between the membranes, 
and in the ventricles of the brain, as well as in the peritoneum; 
the right auricle was filled with coagulated blood; the stomach 
and great intestines were filled with an acrid matter; the mu- 
cous membrane of the small intestine was inflamed, and the gall- 
bladder empty. The body was opened on the eleventh of the 
month, by MM. Ouin and Poteau: the first felt himself in- 
disposed immediately after the examination, and endeavoured, 
but in vain, to brave the disease; on the fourteenth, he was con- 
fined to bed, and on the thirtieth was cured. 

This epidemic having attacked only a limited number of per- 
sons, there was an opportunity for acquiring information of a 



YELLOW FEVER. 337 

more certain character with regard to it, and it is thus proved, 
that a ship coming from the Havana, may be the cause of the 
development of the yellow fever in a town, even when the dis- 
ease had not existed on board the vessel; at the same time, it 
must be admitted, that the development of the epidemic was fa- 
voured by a diversity of circumstances. This fact gives much 
room for reflection, and establishes the necessity of taking pre- 
cautions against vessels arriving from America. It is to be ob- 
served, that the brig had made a quarantine of ten days, at Co- 
rogne, and that it arrived at Port du Passage six days after; the 
cargo was discharged on the sixth, on the fifteenth the custom- 
house officer who had passed several nights on board was taken 
sick, and died on the seventeenth, with symptoms of yellow fe- 
ver: on the fifteenth, likewise, two carpenters employed in re- 
pairing the vessels were taken sick, and died on the twenty- 
ninth. On the twenty-sixth, three men, also carpenters, were 
seized, and died, one on the thirtieth, two others on the thirty- 
first The disease extended to the houses nearest to the vessel, 
although they were situated in the finest part of the town. The 
most unhealthy part escaped. The epidemic commenced as soon 
as the brig was opened; it advanced with the hot season, and 
ceased immediately on the appearance of rain.* 

Since the commencement of the nineteenth century, Gibral- 
tar has been the theatre of several epidemics. The last of them 
was in 1828, and has attracted in a special manner the attention 
of the French physicians, inconsequence of a recent and memo- 
rable discussion to which it gave rise, as well as of the medical 
commissioner appointed to investigate the disease, according to 
the suggestion of M. Chervin. I proceed to give a summary of 
the information which we possess, with regard to this epidemic. 

The disease made its appearance on the tenth or twelfth of Au- 
gust, in an elevated part of the town, to which it was confined 
for the space of three weeks, although no precautionary mea- 
sures were taken against its extension. At the termination of 
this period, it appeared in other quarters, and before the end 
of September, the whole town, as well as the rest of the wes- 
tern aspect of the rock, was invaded by the epidemic. 

During the space of a month, the government considered the 

* Notice Topographique du Port du Passage dans les An. de la Med. Phys. 
iv. p. 505. 

43 



338 PHYSIOLOGICAL PYRETOLOGY. 

prevailing disease only as an autumnal bilious remittent fever- 
existing under an aggravated form, and this opinion is still enter- 
tained by all the English physicians who witnessed the epi- 
demic. 

The contagionists and infectionists agree in this one point, that 
the disease in question is identical with the yellow fever of Ame- 
rica, as well as with that which has appeared at diverse periods 
in the south of Spain. M. Chervin, in particular, who has wit- 
nessed the epidemic yellow fever several times in the new world, 
is a firm believer in this identity. 

The symptoms presented by the epidemic of Gibraltar, resem- 
bled those of epidemic yellow fever in general: as they have 
been already described, it is unnecessary to repeat them here. 

Death generally occurred from the 7th to the 10th day, but in 
some cases not until the second week, and sometimes at a much 
later period. Relapses were frequent and often fatal. Some cases 
of second attacks were likewise observed. The disease was more 
fatal among men than among women, and it presented a charac- 
ter of much greater severity among the military and the En- 
glish in general, than among the mass of the population, com- 
posed of Spaniards and Italians: among the latter, children were 
very slightly attacked. The total number of sick, during the 
epidemic was about 3,500, and the number of deaths 1,660. 
Had there been no removals from the place, the number of 
deaths would doubtless have been doubled. We do not perceive, 
that the dissections, made during the last epidemic at Gibraltar, 
present any thing new. The pathological lesions observed, were 
principally in the gastro-hepatic apparatus. The mucous mem- 
brane of the stomach was red, either over its whole extent or 
only in some of its parts. It was generally more or less easily 
detached from the muscular membrane, and on attempting to 
raise it in shreds, it tore readily; in certain cases it was impos- 
sible to detach it in strips more than two or three lines in length, 
with whatever care the attempt was made. Analogous altera- 
tions were remarked on the mucous membrane of the intestines, 
especially in the small intestines.* 

The liver presented different colours, generally a pale olive 

^Voy. Son Expose des Lesions Pathologiques Observees sur les Cadavres 
des individus morts de la Fievre jaune pendant l'Epidemee de Gibraltar, 
in 1838. 



YELLOW FEVER. 339 

green, making a considerable approach to that of the powder of 
Columbo. The numerous common sewers, which exist under 
the streets of Gibraltar, were one of the principal causes to which 
was attributed the production of the last epidemic which pre- 
vailed in that town. These sewers receive not only the rain, 
the refuse water of the houses, the remains of large quantities of 
vegetable and animal substances, but likewise the contents of all 
the privies. This state of things can give rise to no inconve- 
nience during the rainy season, because the putrefying matters 
are carried off immediately, or in a very short time; but this is 
not the case during the dry season, the duration of which at Gib- 
raltar, is generally live or six months. June, July, August, and 
September, frequently pass without any rain. The sewers during 
this time, become the receptacles of a great quantity of vegeta- 
ble and animal substances, which, operated upon by moisture 
and a high temperature, soon enter into decomposition, and give 
rise to exhalations which necessarily contribute to vitiate the at- 
mosphere. 

This vitiation would, in all probability, not occur, if there 
was sufficient ventilation at Gibraltar: but this is not the case; 
the eastern wind is intercepted by a mountain, which rises to 
the height of two hundred feet above the most elevated part of 
the town, and above the level of the sea, more than four hundred 
feet. On the other hand, when the western wind prevails, it 
strikes directly upon the rock, penetrates into the principal 
sewers which open upon the shore, and thus drives back their 
effluvia upon the upper part of the town. This wind prevailed 
in an extraordinary manner during the last summer, and in con- 
sequence, the epidemic was observed to commence in an elevated 
situation, which corresponded to one of the principal sewers, 
and which likewise suffered from insufficient ventilation. Was 
this a mere coincidence? The more probable opinion is, that it 
was not. 

A diversity of additional causes are pointed out, as having con- 
tributed to the production of the last epidemic at Gibraltar, such 
as the density of the population, its poverty, the smallness and 
filthiness of the houses in general, and in many cases, the almost 
total want of ventilation. We may add, that these disadvan- 
tages are not altogether confined to the houses of the poor, and 
that the whole town sometimes suffers from a stagnant atmos- 
phere. 



340 PHYSIOLOGICAL PYRETOLOGY. 

A great number of persons visited and attended the sick, and 
were in immediate contact with them, without, however, con- 
tracting the disease; whilst many who neither had any commu- 
nication with the sick, nor touched the objects considered as con- 
tagious, were attacked. What appeared most pernicious was ex- 
posure to the night air in infected places; thus, the soldiers were 
generally attacked after having been on guard in such places, al- 
though they did not approach the sick. 

If the cause of medical science has not been promoted by the 
last epidemic, in relation to practice, much light has, notwith- 
standing, been thrown upon the origin and character of yellow 
fever, and the question of the non-importation and non-contagion 
of the disease, seems to have been solved in a definitive manner, 
by the facts observed at Gibraltar in 1828. 

When M. Chervin applied to the government to be sent to the 
theatre of the epidemic, he desired that a contagionist might be 
associated with him, in the commission. In place of one, two 
were appointed: viz. MM. Louis and Trousseau. During the 
whole course of their investigations, the colleagues of M. Cher- 
vin displayed an ardent zeal for contagion. They made every 
effort to collect facts corroborative of their opinion, which was 
also that of the administrator who had sent them: notwithstand- 
ing which, they have not pronounced with regard to the origin 
and character of the epidemic which they were sent to observe; 
whilst M. Chervin, and almost all the English physicians and 
surgeons who witnessed the epidemic, are convinced that the 
disease had a local origin, and that it was not contagious. This 
fact cannot but be very important in the decision of this ques- 
tion, and it acquires additional force, when it is known that of 
the three English physicians who declared in favour of the doc- 
trine of importation and contagion, one is Dr. Pym, superin- 
tendant-general of quarantines in England, another, Dr. Broad- 
foot, physician of quarantine at Gibraltar, and the third, Dr. 
Barry, who was one of the strongest partisans of local origin 
and non-contagion, before the arrival of the superintendant-ge- 
neral at Gibraltar, about the end of November, 1828. 

The proofs of the non-contagion of yellow fever, were ex- 
tremely numerous in the last epidemic at Gibraltar; I shall not 
here enumerate them; but merely state the impression left by 
them on my own mind. We remarked, that this disease did not 



YELLOW FEVER. 341 

propagate itself on the European side, and neither Moulin-a-Vent 
nor Champ Neutre, nor the ships moored in the bay, were in- 
fected, although the disease had been frequently carried to these 
several places, by persons who had contracted it in the infected 
district. Those who are desirous of the most detailed account 
of the last epidemic of Gibraltar, may consult the writings of M. 
Chervin, as well as those of MM. Gillorist, Wilson, and Frazer, 
English physicians who were present during the epidemic, and 
who engaged in the investigation with much zeal. 



Treatment of the Yellow Fever, 

A residence in the most elevated part of the country in which 
the disease prevails, and at as great a distance as possible from 
the sea-shore; sobriety, moderation in the use of the fruits of 
the climate, temperance in venereal indulgence, and in study, 
firmness of character, enabling the individual to banish all fear, 
unremitting care in avoiding every thing which may suppress the 
perspiratory action of the skin; such are the conditions in which 
the individual should be placed, and the precautions which he 
should take to preserve himself against the yellow fever. 

It cannot be too deeply impressed upon the mind, that the 
therapeutic measures have been founded less upon experience 
than upon theoretical ideas. Nothing proves this more forci- 
bly than the diversity of curative means recommended by phy- 
sicians who have written upon the subject. Some behold in 
this disease only a bilious fever, and prescribe vomiting and 
purging: some consider it an inflammatory fever, and recom- 
mend blood-letting: the greatest number attribute the disease to 
astheny, and, notwithstanding the numerous symptoms which 
manifestly announce intense inflammation, are prodigal in the 
use of bark; others, still less wise, seek for specifics, which some 
think they have discovered. M. Bally has submitted these 
means to examination; which, though severe, should have been 
still more so. 

He has observed some patients become convalescent after a 
copious and long continued discharge of urine, after alvine de- 
jections, varying in colour, from yellow to black, and after abun- 
dant and uniform sweats. Hence, he concludes, that in certain 



342 PHYSIOLOGICAL PYRETOLOGY. 

cases, we may, with advantage, solicit the discharge of urine by 
prescribing lemonade, orangeade slightly bitter, a solution of 
cremor tartar, of the acetate or nitrate of potash; diaphoresis, 
by the employment of friction, of baths, at first warm, after- 
wards warm and cold, alternately, and by administering warm 
drinks. But he does not indicate the cases; and, unless I mis- 
apprehend, he only recommends the favouring of these evacua- 
tions when they already exist. This is, doubtless, proper when 
the symptoms become meliorated on the occurrence of these 
evacuations: but, should we endeavour to promote them when 
the most alarming symptoms accompany them? Is it proper, 
for example, with the view to favour a crisis by stool, to pre- 
scribe tamarinds, castor oil, and laxative lavements, at the risk 
of provoking black or bloody dejections, which almost always 
indicate the approach of death? 

At the present day, it is not only in the quantity of the eva- 
cuations and their colour, but also in the state of the internal 
and external organs that we must seek the indications to be ful- 
filled. 

The same author declares that emetics have seldom succeeded 
in America. An unhappy experience in a short time convinced 
him that they increase gastric irritation, and the disposition to 
vomiting. Vomiting of blood, complete prostration, sudden 
death, and dangerous dysentery, were the effects of emetics, ac- 
cording to his observations. Even ipecacuanha, given with the 
greatest caution, was so dangerous that it was preferable to aban- 
don its use. 

In America, M. Bally prescribed, during the first two days, 
anodyne, mucilaginous, and laxative enemata; when the meteo- 
rism and tension of the epigastrium were considerable, he add- 
ed camphor and quinine, in large doses, to combat prostration, 
and sometimes a considerable quantity of vinegar, to prevent de- 
composition. To prevent hypercatharsis, he prescribed lauda- 
num, or the theriaca. Since his theory compelled him to resort 
to this disturbing treatment, he at least deserves credit for not 
administering them by the mouth. 

The warm bath, in which he kept the patient for several hours, 
and at different times, appeared to him a powerful auxiliary to 
the treatment, when there was no danger of pulmonary conges- 
tion. It would be more rational to fear a congestion of the head, 



YELLOW FEVER. 343 

a congestion which might be prevented by the application of ice 
to the cranium. 

If the warm bath is useful, it is not certain that the same re- 
mark may be made with regard to baths of bark and alcohol, 
which M. Bally did not employ, but which he recommended to 
the attention of practitioners. He did not employ the cold bath, 
which, it is said, is used by the negroes so successfully as to au- 
thorize a trial of it. I should not readily resort to such a mea- 
sure in a disease which menaces both the head and chest. The 
case is not the same with regard to cold applications to the head; 
they are indicated whenever there is an afflux of blood to the 
head, and should be assisted by the abstraction of blood and hot 
pediluvia. M. Bally recommends pediluvia,. rendered stimu- 
lating by mustard or vinegar. 

Hot fomentations applied to the epigastrium, epithems, with 
camphor, opium, and theriaca, frictions, with sulphuric or acetic 
ether, appeared to him to moderate the vomiting. Blisters, which 
he applied to the same part, are directly contra-indicated by the 
nature of the disease. Cups occasion intolerable and dangerous 
pain, if the epigastrium is sensible to pressure. The water of 
orange leaves, of mint, ether and mint, should have been ba- 
nished from the practice of a physician, who, in the multitude of 
post mortem examinations which he made, almost always disco- 
vered a more or less marked state of phlogosis of the stomach. 
It, doubtless, was previously to his researches that he prescribed 
liquid ammonia; after his investigations, he surely would have 
been on his guard against such a measure. Yet, when the alvine 
evacuations became excessive, he gave opiate mixtures, the root 
of columbo, cascarilla, catechu, and sulphuric acid, in union 
with the serpentaria. When meteorism of the abdomen wa3 
not a precursor of a critical movement, when it was owing to ex- 
treme debility, or a gangrenous disposition, (M. Bally does not 
say by what signs he recognised this debility, this disposition,) 
he had recourse, not only to the exciting lavements already men- 
tioned, but likewise to the internal use of the extract or tincture 
of bark, and also of ether and camphor. When there was he- 
morrhage he resorted to cold acidulated lotions, to the mineral 
lemonade, to the decoction of bark and serpentaria, acidulated, 
to the acetate of ammonia, to the sulphuric elixir of Minsicht, to 
the super-sulphate of alumine. 



344 PHYSIOLOGICAL PYRETOLOGY. 

M. Bally is certainly one of the physicians who have sacri- 
ficed least to a blind empiricism, and to the doctrines of Brown, 
in the treatment of yellow fever, and it is on this account that I 
have described his method rather than any other; because he 
persisted for a longer time in the employment of acidulous 
and emollient remedies. We now perceive that the yellow fe- 
ver has been treated in America in the same manner as the ty- 
phus has been in Europe; consequently, the yellow fever being 
in general more fatal than the typhus, and the treatment being 
equally contra-indicated by the state of the organs in both coun- 
tries, it is not surprising that the mortality from the one has 
been even more considerable in America than that of the other 
in Europe. It is proved by the researches of M. de Jonnes, 
that, between the years 1796 and 1802, more than a quarter of 
the French troops sent to the Caribbee islands were cut off by 
the yellow fever. Whatever be the violence of this disease, 
such a result evidently demonstrates that the treatment hitherto 
employed should be abandoned: certainly it would be difficult 
to point out the impropriety of substituting another mode of 
treatment, or even of abandoning the disease to nature, in pre- 
ference to continuing a practice so inefficient or injurious. " In 
the month of December, 1802," says M. Bally, " I was attacked 
by the prevailing disease, in consequence of sleeping on board 
a man-of-war, which was in the road-stead: here I was pene- 
trated by a humid cold, from which I found it impossible to pro- 
tect myself. The next day I felt no indisposition; but, on the 
following morning, at two o'clock, I was seized with a rigor, 
which lasted half an hour, and which was followed by conside- 
rable heat and profuse sweat; my body was immediately assailed 
throughout with pains, and the kidneys, in particular, were vio- 
lently affected. They persisted during five days, and that of the 
kidneys continued until the ninth; the fever was marked by a 
strong exacerbation towards evening, by intense heat, more re- 
markable in the hands and feet, and by an increase of the in- 
tense pain which pervaded the whole body. Sometimes I was 
sensible of some confusion of intellect, but I was not delirious. 
I preserved a state of uninterrupted calmness and tranquillity. 
My sleep was interrupted, and was seldom tranquil; my tongue 
was loaded, white in the centre, and clean on the edges; thirst 
moderate, salivation abundant, mouth clammy. The organs of 



YELLOW FEVER. 345 

taste and smell had acquired such acuteness, that I could distin- 
guish in water the aromatic savour and odour communicated to 
it by the flowers which fell into the stream, a delicacy of percep- 
tion to which I was a stranger during health. Whenever my 
feet were immersed in the water, I was seized with a general 
spasm, more sensibly and painfully felt in the stomach: the 
spasm was followed by pain and syncope; but after this first ef- 
fect had passed, the pediluvium appeared to have a soothing ef- 
fect, and I remained in it with pleasure. It was readily per- 
ceived that the stomach was the seat of an affection, from its 
liability to painful contraction, from the frequent eructations,, 
vomiting, and want of appetite. A gentle purgative was admi- 
nistered, which was immediately rejected, and which fortunate- 
ly produced no effect. Lavements occasioned dejections of 
whitish matters, the urine was free, and respiration easy. I 
could not support any kind of drink; every thing appeared to 
me either insipid and nauseous, or too strong: it was, therefore, 
necessary to confine myself to simple water. I remained in this 
state for ten days, and my convalescence was neither long nor 
painful. I took no kind of medicine. The effects of simple 
water, were assisted by a general bath, by pediluvia, and by 
lavements." 

Were I suffering under the yellow fever, I should certainly 
desire to be treated as M. Bally was; and I cannot but remark 
on the present occasion, the similarity of his conduct to that of 
Hildenbrand. Differing from Chirac, who employed the same 
method in his own case, which he prescribed for his patients, 
these two physicians wisely preferred the danger of their disease 
to that of the treatment. 

There is one measure with regard to which experience has 
not yet pronounced; I mean the abstraction of blood. Almost 
all the physicians who have seen the yellow fever, regret blood- 
letting in this disease. Some, Deveze and M. Dalmus among 
others, recommend it at the commencement, and when the symp- 
toms have a very marked inflammatory character. A few, and 
among these Mosely, advise the repetition of blood-letting until 
the symptoms decrease in intensity. The first trials of this mea- 
sure, which M. Bally made, succeeded so badly that he hastened 
to follow an opposite plan: "I observed," he remarks, " that 
the patients who were bled by the routine of practitioners of the 

44 



346 PHYSIOLOGICAL PYRETOLOGY. 

country, died two days sooner than was usual in other eases: 
viz., about the fifth, instead of the seventh day." Independently 
of these results, we are not inclined to class venesection among 
the remedial measures in this disease, since it is seldom useful 
in gastro-enteritis. The only cases in which it can be resorted 
to with advantage, is when the lung is on the point of being in- 
flamed, or delirium about to supervene. 

M. Rochoux advises five or six bleedings in the space of forty 
or sixty hours from the commencement of the attack; he thinks 
that if the second day be allowed to elapse without employing' this 
measure, it should not be resorted to. Leeches appeared to him 
of very secondary utility, on account of the rapid progress of the 
disease; yet he advised the application of twelve or fifteen to the 
epigastrium, when after venesection there remained an acute 
pain in this part, although the general excitement had been 
calmed. This physician appears to me to have totally misun- 
derstood the treatment of gastro-enteritis. If an acute pain per- 
sists, after venesection has been practised five or six times, it is 
evident that this measure has diminished the acceleration of the 
circulation, without dissipating the local phlegmasia which had 
determined the acceleration; whence we may conclude that in 
such cases venesection does not affect the focus of disease, and 
that it only debilitates the patient. 

M. Rochoux remarks that the bites of the leeches sometimes 
occasion the flow of an enormous quantity of blood, against 
which most of the topical applications are found inefficient; in 
almost all cases it is necessary to resort to cauterization with the 
nitrate of silver. He thinks this tendency of the capillaries to pour 
out blood, is more rare among acclimated persons. I may remark 
that I have frequently observed these hemorrhages in Paris, 
among adults, and much more frequently among infants, when 
there was a considerable acceleration of the circulation, and par- 
ticularly in very intense gastro-enteritis. I have frequently re- 
garded the obstinate flow of blood as indicating the necessity of 
abstracting a great quantity, and I have always had reason to be 
gratified that I had not arrested the hemorrhage until the ap- 
proach of syncope. Whether the same course would be ad- 
visable in the yellow fever, I am incapable of saying. Would 
the bites of twelve or fifteen leeches furnish more blood than ve- 
nesection five or six times repeated in the course of forty or sixty 



j YELLOW FEVER. 347 

hours — with a loss of twelve or sixteen ounces each time. This 
is improbable, since it would be necessary for this purpose, that 
each bite should furnish more than five or six ounces of blood 
in the course of twenty-four hours, the mean duration of a he- 
morrhage caused by so slight a wound. 

It is much to be desired, that methodical researches should be 
made by physicians, with regard to the effect of a great number 
of leeches applied to the epigastrium at the commencement of 
yellow fever, and during the first stage of this disease. To ren- 
der such researches conclusive, it would be necessary to pre- 
scribe at the same time a severe diet, acidulated and gummy 
drinks, or simple water in repeated doses, emollient fomenta- 
tions, lavements, hot pediluvia and warm baths. The results of 
these measures should be patiently awaited without resorting to 
the employment of tonics, even when a fancied degeneration of 
the disease, or pretended complications appear to necessitate 
their employment. Until this be done, the yellow fever will 
rest a deplorable monument of the most blind and dangerous em- 
piricism. 

When the preceding remarks were first made by me, I was 
not aware that experience had converted into certainty the pre- 
sumptions of theory. The epidemic of Port du Passage, fur- 
nished M. Jourdain the opportunity of investigating this sub- 
ject. Most of the patients, although they were violently at- 
tacked, and presented the most alarming symptoms, preserved 
their muscular power until the last moments of life. The yel- 
low colour of the skin invariably increased after death. Gene- 
ral blood-letting was fatal in most cases. Emetics always ag- 
gravated the disease, particularly when administered in the com- 
mencement. Lavements of salt water or vinegar were injurious. 
Mucilaginous and emollient drinks, lavements, cataplasms, and 
fomentations were very advantageous; oleaginous remedies were 
also useful. Leeches applied at the commencement, to the epi- 
gastrium, always arrested its progress; but they were generally 
applied in too small a number, or after the employment of inju- 
dicious and dangerous measures, such as general blood-letting 
and emetics. External stimulants, sinapisms and blisters were 
useful at the termination of the second period of the disease, as 
powerful resolvents. Internal stimulants and bark, were not 
employed by any of the physicians who treated this disease at 



348 PHYSIOLOGICAL PYRETOLOGY. 

Port du Passage; all were convinced that the disease was more 
or less inflammatory. 

Had M. Jourdain confined himself to these assertions, he 
would have imitated all other writers on epidemics, but he has 
done more, he has given the history of all the patients in a sin- 
gle synoptical table: his example is worthy of imitation in all si- 
milar cases. 

Of sixty-five patients, leeches were prescribed for thirty-nine. 
In some cases the number was small; in one case their applica- 
tion was neglected: of the thirty -nine, nine died. Eleven were 
bled, and afterwards leeched: of these, six died; three were 
bled, and, died: two were leeched after an emetic, and died: one 
took an emetic and was bled, he died: nine used mucilaginous 
and acidulated drinks, and to some of them blisters were applied, 
and three died. This medical arithmetic is a decisive answer to 
the abettors of gastric embarrassment, and gastricity. Why is 
it that the physicians sent to Barcelona have only given us vague 
statements, instead of this interesting detail? 

In a report replete with extended and profound views, M. 
Dupuytren considers the subject in all its bearings: he does not 
think that the experiments proposed by MM. Costa and Las- 
serve are sufficient to solve the question of contagion: he only 
regards them as one of the means of arriving at this desirable 
solution, and as the commencement of a series of experiments 
which should be instituted, with the view of deciding whether 
the yellow fever be contagious, and if so, under what circum- 
stances. The commission, of which M. Dupuytren was the or- 
gan, proposed a convention, to which medical men of every 
'country should be admitted, and to assign a large prize for the in- 
vestigation which should contribute most to the elucidation of all 
questions relative to the seat, nature, development, and propaga- 
tion of the yellow fever. Let us hope for the execution of this 
noble project, and that France will again appear conspicuous in 
the promotion of philanthropic enterprises. 



THE PLAGUE. 349 



CHAPTER IX. 

Of the Plague. 

The name of plague is generally given to diseases which in- 
fect at one time the greater part of the inhabitants of a country, 
and which carry off in a few days most of those who are affected: 
but, according to many physicians, the rapidity with which 
death occurs, and the immense number of deaths are not the 
only characteristics of pestilential diseases. It is essential to the 
character of plague, that in addition to the symptoms common 
to all dangerous fevers, there should be buboes and carbuncles, 
if not in all cases, at least, in most. Petechias are no longer 
considered as symptoms peculiar to the plague, although they 
often accompany diseases which are designated by this name: it 
may thus be perceived, that this name is more limited in its 
signification than formerly. 

The plagues which have ravaged the earth, having presented 
remarkable differences, any general description that might be 
given, would not very accurately delineate any particular epi- 
demic: on this account, I proceed to give a brief account of 
some of the most remarkable, that of Nimeguen, Marseilles, of 
Moscow, of Egypt, and of Noja. 

1. Diemerbroeck observed the following symptoms in the 
plague which desolated Nimeguen, from the beginning of No- 
vember, in 1635, until that of March, in 1637. 

Agitation, extreme anxiety, often considerable internal heat, 
pains of the head seldom lancinating, generally dull and heavy, ter- 
ror, delirium, convulsive itchings, and slight contractions of the 
limbs: continual somnolence in some, profound stupor in others, 
deranged vision, tinnitus aurium, deafness in some: dryness, 
and sometimes, though seldom, blackness of the tongue; fetor of 
the mouth, and sweat; syncope, pulse often strong and natural, 
sometimes weak, frequent and unequal, in some, intermittent, 



350 PHYSIOLOGICAL PYRETOLOGY. 

in many, very small, frequent, sometimes regular, and sometimes 
the reverse. Hemoptysis, small dry cough, thirst, want of ap- 
petite, pain at the orifice of the stomach, nausea, vomiting, hic- 
cough, alvine dejections, crude, extremely fetid, containing 
worms; pernicious diarrhoea. Urine, in many, not varying from 
that of health; in others, scanty and crude, and sometimes, like- 
wise turbid; in some, healthy and turbid in the same day; occa- 
sionally, sanguinolent. In some, sudden prostration of muscu- 
lar force and difficulty in moving, from the commencement of 
the attack; in others, the strength continuing unimpaired to the 
last. Heat of the body, in some acrid to the touch, and in 
others, natural. Complexion pale in some, and erysipelatous in 
others, in many, varying but little from a state of health. Spots 
of a purple, red, violet, or black colour, sometimes very nu- 
merous, small or large, almost always round, appearing some- 
times on one part of the body, sometimes on another, occasion- 
ally, over the whole surface. Glandular tumours behind the 
ears, on the neck, in the arm-pits and groins; carbuncles on dif- 
ferent parts of the body. 

All these phenomena did not constantly appear in every sub- 
ject. Buboes were considered one of the most certain signs of 
the pestilential character of the epidemic, as well as carbuncle 
and exanthems. The carbuncles usually commenced with one 
or two small pustules of the size of a grain of millet: as they 
increased in 'size, the subjacent part died as though it had been 
cauterized, and it became black. Several of these pustules co- 
alesced, and formed a single one, filled with a black ichor, 
around which a high inflammation was developed. Among the 
carbuncles, some were small, others large; sometimes they were 
observed to extend to a distance, and occasioned, in a short time, 
gangrene of the neighbouring parts. 

The disease appeared after a damp spring, during a very hot 
and dry summer; the following winter was not very cold, nor 
was it remarkable for either dryness or humidity. ' The epide- 
mic raged with the utmost violence from the end of April to 
the end of October: it ceased on the commencement of frost. 
The number of deaths was immense, no house escaped. Die- 
rnerbroeck believed that it communicated itself equally by me- 
diate and immediate contact.* He considered it as originating 

* Tractatua de Peste. Amsterdam, in 4to, p. 17, et seq. 



THE PLAGUE. 351 

in an atmospheric cause, of a very malignant, occult, and poi- 
sonous character, existing in the air. Impurity of the atmos- 
phere, individual constitution, local causes, and bad regimen, 
were, according to him, only circumstances favourable to the de- 
velopment of the action of this occult cause. He adopted in 
full, the opinion of Fracastor and Mercuriale, with regard to 
the proximate cause, and the propagation of the plague. 

2. The plague of Marseilles was often preceded by disgust, 
nausea, vertigo, and pains in the legs; sometimes it supervened 
suddenly, and almost always commenced with a slight chill, 
precordial uneasiness, nausea, vomiting, often by the discharge 
of a quantity of worms, by headache, dizziness; the rigor was al- 
ways succeeded by a violent fever, attended with acrid and 
burning heat. Yet the disease presented itself under two dif-v 
ferent forms: sometimes the symptoms were of slight intensity 
for several days, and sometimes they were violent from the com- 
mencement. In the first case, recovery occurred with consi- 
derable frequency; in the second, some died suddenly within six 
or eight hours, some in twenty-four hours, the greater number 
in two or three days. When the disease continued longer than 
the third day, there was a hope of recovery, and when conva- 
lescence occurred in any case, eruptions appeared, and developed 
themselves more and more; in fatal cases they did not occur, or 
they disappeared. This disappearance of the eruptions was al- 
ways followed by death, which sometimes supervened unexpect- 
edly, when the patient was much better, and thought himself 
cured. Petechiae, far from being a happy omen, like bubo and 
anthrax, almost always indicated a fatal termination, especially 
when they became black. Buboes appeared in the groin, often 
lower down, in the arm-pits, the neck, and on the parotids; their 
appearance in the commencement afforded no grounds of prog- 
nosis; those which appeared on the second or third day, gene- 
rally coincided with a diminution of the other symptoms; those 
of the neck and parotids were almost always followed by death; 
when they were double, they occasioned suffocation. The sup- 
puration of the buboes did not commence until the disease dimi- 
nished. The carbuncles and pustules appeared at all periods of 
the disease, on every part of the body, often below the buboes: 
their appearance was almost always followed by a melioration of 
the condition of the patient, but those of the neck almost al- 



352 PHYSIOLOGICAL PYRETOLOGY. 

ways preceded a fatal termination. The pustules resembled 
small and very painful boils, red at the base, and white at the 
summit, which dried and became black; the tumour then ex- 
tended, and the neighbouring parts became hard, and the red- 
ness diminished. When they appeared over the buboes and pa- 
rotids, death was to be apprehended. 

The most usual symptoms, in addition to those which have 
been pointed out, were syncope, oppression, diarrhoea, frequent- 
ly a considerable discharge of worms, hemorrhage, stupor, deli- 
rium, frequently convulsions, except when there were no erup- 
tions, or when they developed themselves slowly. The tongue 
was generally white and loaded, the thirst excessive, even when 
the fever was slightest, the eyes were sparkling, even during 
syncope, the countenance exhibited terror, as in hydrophobia. 
The excrements were not very fetid; the urine, almost always 
natural, was sometimes covered with an oily pellicle; sometimes 
it was slightly red, especially on the first day, and when the fe- 
ver was violent; in some cases it was very red, and almost of 
the colour of blood. After the lapse of some days, a sweetish 
odour was perceptible, especially when the patient perspired; 
this odour was very disagreeable, although not very strong; it 
was communicated to every thing which had been used by the 
patients, even to the furniture and chambers, and it did not dis- 
appear until the tainted articles had been washed in boiling wa- 
ter, and exposed a long time to the air. 

When recovery occurred, it was generally from the eighth to 
the tenth day, or, at least, after this period; if some symptoms 
still continued, the patient was, nevertheless, out of danger: all 
that was necessary was a continuance of the local treatment of 
the buboes and carbuncles. 

This is the brief description given by Bertrand of a disease 
which, according to official documents, destroyed more than 
thirty-nine thousand of the inhabitants of Marseilles; and, ac- 
cording to this author, fifty thousand from the 10th of July, 
1720, to the month of February, 1721. It first appeared among 
the poor, in a crowded street. The first patient had only a sin- 
gle carbuncle; by degrees the number of patients increased; car- 
buncles and buboes appeared in great numbers; as early as the 
20th of July, the mortality was frightful: after the 1st of Au- 
gust, the disease pervaded every district of the town: before the 



THE PLAGUE. 353 

10th of this month, it was almost in every street, and in the 
middle of the month in almost every house: during the rest of 
the month, and the whole of September, a thousand sometimes 
died in a da}': in October it was less fatal, and it gradually abated 
in the following months. The rich were its victims as well as 
the poor. Infants and women were first attacked, and then 
adults: decrepit old men alone were spared. The town was co- 
vered with the sick, abandoned with horror by their relations, 
or who had left their houses for the purpose of gaining admis- 
sion into the hospitals. Heaps of bodies were seen in the streets, 
exposed to the rays of the sun for more than three weeks, and 
serving as food for dogs. 

According to Bertrand, and most of the other physicians of 
Marseilles, the cause of this plague was an unknown matter, im- 
ported by a vessel which had arrived from Sidon, in Syria, on 
the 25th of May, 1720, and the crew of which entered the town 
on the 4th of June. The porters who opened the bales of cot- 
ton, with which this vessel was freighted, were immediately at- 
tacked with continued fever, attended with small pulse, pain in 
the head, nausea, and vomiting; in some cases without any ex- 
ternal affection, in others, with buboes and pustules. After this 
a woman died with a carbuncle on her lip, another with a car- 
buncle on her nose, and a third with buboes: after these, all the 
inhabitants of the street were affected. The disease first ap- 
peared in the houses nearest that of the first of these three wo- 
men. It first assailed dealers in old clothes, tailors, and smug- 
glers. The men employed in removing the dead bodies, almost 
all perished. The convents, which preserved themselves in a 
state of strict isolation, escaped. Every circumstance proves 
that the disease w-as communicated to the healthy by the sick; 
that the contact of the patients, or of articles belonging to them 
or the inspiration of the miasm exhaled by the former, or ad- 
hering to the latter, should be classed among the circumstances 
which favour the development of this disease, if they were not 
the only causes of the epidemic. 

Deidier, Chicoyneau, Verny, and Soulier attributed this dis- 
ease solely to an unequal temperature and errors in diet; but the 
physicians of Marseilles, on the one hand, deny these two circum- 
stances, and, on the other, ask why they should "have produced 
such frightful results in 1820 and 1821, when they had occa- 

45 



354 PHYSIOLOGICAL PYRETOLOGY. 

sioned nothing of the same kind in 1719. Deidier asserts that 
a woman died with an inflammation of the parotid gland, that 
another had a carbuncle, and a third a bubo, with fever, before 
the arrival of the suspected vessel. The last two did not die. 
Does the carbuncle of the second fully demonstrate that the 
plague existed at Marseilles on the 9th of May? It certainly is 
true that the guardians of the public health were very culpable 
in not strictly enforcing the sanitary regulations in the case of 
the vessel from Sidon. 

If Chicoyneau, Verny, and Soulier displayed more complai- 
sance than logic, in their opinion with regard to the propagation 
of the plague, the latter, nevertheless, examined bodies in the 
presence of his colleagues. Three patients were examined who 
had been affected with irregular chills, universal coldness, a pulse 
very small, soft, frequent, unequal, concentrated, considerable 
weight of the head, a giddiness, resembling that of intoxication, 
the looks fixed, the eye dull, speech slow, interrupted, plaintive, 
expressing terror: the tongue at first white, towards the termi- 
nation dry, reddish, black, rough; the face pale, leaden, lan- 
guid, cadaverous; precordial distress, frequent nausea, great in- 
quietude, general prostration, absence of mind, stupor, nausea, 
vomiting; they died before the third day, without any eruption, 
tumour, or spot. On dissection, the viscera of the abdomen and 
chest were found livid, blackish, or of a deep red; the vessels 
were filled with blood of the same colour. Reticulated vessels 
appeared upon the membranes, enveloping the intestines, sto- 
mach, lungs, and pericardium; neither the head nor the diges- 
tive canal were opened. 

Six patients, of full and robust habit, presented the same 
symptoms as the preceding; but in them, after the rigors, the 
pulse was active and developed, yielding readily to pressure; 
they had experienced, internally, a burning heat, a moderate de- 
gree of heat externally, unquenchable thirst: their speech was 
rapid and stammering, their eyes reddish, wandering, sparkling; 
the face of a bright, and sometimes of a livid red; less precor- 
dial distress than in the preceding cases; respiration frequent, la- 
borious, or large and unfrequent, without cough or pain; nausea, 
bilious, greenish, blackish, and bloody vomiting; diarrhoea of 
the same kind, without any pain or tension of the abdomen; de- 
lirium; urine often natural, sometimes turbid, whitish, blackish, 



THE PLAGUE. 355 

bloody; sweat somewhat fetid, and succeeded by great debility; 
small hemorrhage, always followed by the same result; great 
prostration and terror; finally, from the commencement, very 
painful buboes, carbuncles, whitish pustules, or purple spots; 
the vessels of the brain, those of its membranes and the sinuses, 
were found filled with blackish and coagulated blood; there was 
gangrenous inflammation of the lungs; the heart and liver, which 
were very large, were without change of colour or alteration of 
texture; the gall-bladder, stomach, and intestines were filled with 
bile of a deep green; the glands, which formed the buboes, were 
gangrenous, blackish, livid, and purulent. These disorders were 
common to six bodies; in some there were internal carbuncles; 
livid and purple spots, similar to those of the exterior of the 
body, affecting the stomach, which was filled with worms, and 
with a blackish and horribly fetid blood. Yet the authors who 
report these facts, assure us that none of the dead bodies exhaled 
an offensive odour, like that of persons who die of hospital gan- 
grene, which has been of some continuance. It would appear 
that they examined the digestive canal merely with the view of 
discovering what liquids they contained, for they mention but 
once the state of the mucous membrane. 

Soulier also opened three bodies at Aix. Besides the com- 
mon derangement, he found in one a carbuncle of a black colour 
in the ilium; in another, the internal membrane of the intestines 
was marked by a number of purple spots, in a third, it was 
marked with black patches. 

Couzier opened eleven bodies at Alais, one of the towns of 
Provence in which the plague appeared. In almost every case 
he found, besides the traces of cerebral congestion, and of in- 
flammation of the meninges, an enlargement of the heart and 
liver, bile in the digestive canal, purple spots and carbuncles on 
the lungs, on the internal as well as the external surface of the 
stomach and small intestines, upon the epiploon, the mesentery, 
the liver, the pericardium, the gall-bladder, the diaphragm, the 
kidneys, the abdominal aorta, and even the pancreas. The vis- 
cera are here mentioned in the order of the frequency of their 
alterations. * 

* Observations et Reflections touchant le Nature lea Evenemens et le 
Traitement dc la Pcste de Marseille. Lyons, 1721, in 12mo. 



356 PHYSIOLOGICAL PYRETOLOGY. 

3. Samoi'lowitz distinguished in the plague of Russia three 
stages or degrees: the first characterized usually by buboes alone, 
occasionally by petechias, always of a small size, very seldom by 
carbuncles, and by pains in the head and vomiting; the second 
characterized by continued headach and repeated vomitings, by 
large, black, and confluent petechise, which, on the approach of 
death, were transformed into yellowish pustules, below which, 
on examination is found a carbuncle; finally, by very few bu- 
boes: in the third period, to the preceding phenomena is added 
delirium. To these symptoms must be added the following, 
which announced or accompanied the development of this dis- 
ease: deep sadness, weeping without cause, considerable prostra- 
tion, slight rigour, vertigo, weight and pain of the head, some- 
times very acute, a little above the frontal sinuses, eyes painful, 
watery, prominent, looks fixed or wandering, sense of weight in 
the eye-lids; internal and external heat, burning skin, tongue 
dry, covered with a thick, yellowish coating: sometimes no 
ehange in the colour of the tongue: face pale and emaciated, in- 
supportable anxiety, agitation, frequent syncope, nausea, vomit- 
ing of food, or of yellowish or greenish matters, trembling, som- 
nolence, sudden starting from sleep with alarm, embarrassment 
in speech, aphony, terror, incontinence of urine, diarrhoea; in 
women menorrhagy or abortion; in men sometimes epistaxis, 
or hemorrhage from the fauces. Instead of somnolence, there 
was frequently delirium, w r hich ceasing suddenly in one or two 
days, indicated the approach of death, which usually occurred in 
the evening, or during the night.* 

The plague of Russia was attributed to the communication of 
the soldiers with the Turks. Samoi'lowitz has collected the facts 
which tend to prove that it communicated itself by contact, and 
that the only means of escaping was by avoiding all communi- 
cation with the sick, or at least by not touching them, or any 
article which had been in contact with them. It continued from 
the month of April, 1771, to March, 1772, and destroyed 
133,299 persons, 7268 in August, 21,404 in September, 17,561 
in October, 5,233 in November, the months during which it 
raged with the greatest activity. 

* Memoire sur la Peste qui en 1771 ravaged 1'empire de Russie et surtoui 
Moscou, le capitale. Paris, 1783, in 8vo. 



THE PLAGUE. 357 

Samoilowitz opened no bodies during this epidemic, because 
he found such researches of little utility; but, at a later period, 
having made no satisfactory discovery with regard to the nature 
of plague, by means of the microscope, with which he examined 
the pus of the buboes, while he was at Cherson, he finally de- 
cided on making dissections. The articulations of these subjects 
were flexible, and their flesh very soft. He remarks, that he 
found all the internal parts of the head in the same state as after 
death from ordinary causes; the intestines, stomach, gall-blad- 
der, and the other parts of the abdomen were a little swelled, 
the great lobe of the liver slightly inflamed, the diaphragm, 
lungs and pericardium in a healthy condition; no blood in the 
ventricles of the heart, but a yellowish matter resembling goose- 
grease, and therefore analogous to the concretions since found in 
the bodies of subjects who had died of yellow fever. Samoilo- 
witz made a chymical analysis of this yellow matter, and con- 
cluded, 1st, That the plague has its seat in the heart; 2dly, That 
the pestilential poison is only a fluid oily matter; 3dly, That this 
poison acts upon the body by contact. This only proves the fa- 
cility with which Samoilowitz drew conclusions, and that he 
opened but few bodies. 

4. The plague which ravaged the French army in Egypt af- 
forded M. Desgenettes an opportunity of making important re- 
marks with regard to this disease. His language is as follows: — 

" The plague is endemic in Lower Egypt, and along the coast 
of Syria, since it has reigned there for some ages, and since it 
has been observed a hundred times in places which had no kind 
of communication with each other. 

"The plague generally appeared at a particular season, but 
there have been instances of its occurrence at all periods of the 
year." 

" Southern winds, a hot and damp air, favour, if they do not 
alone produce its development. Northern winds and the ex- 
tremes of heat and cold entirely arrest it." 

"The plague more particularly attacks men, who, from their 
occupation, are under the necessity of passing suddenly from a 
hot to a cold atmosphere, or vice versa: such as bakers, smiths, 
cooks, &c. ; women, young persons, even infants at the breast, 
have generally resisted the epidemic better than the most robust 
men. 



i:f ? ht5 ::!•::-::. t.1 ?ttlit:i: :-t. 



••?f:~:zri: iriiz?.. 5 : 7. :-.5 :?;;-: rs ni 5*11:15. : ::.izr:-:? -ni- 
as hopes and itrh. venereal dJSFasrei Tpre Hmi wn» m«te 
or dkcars. wish copious iumpmii iiliiim^ wore no preventives c : 

p7.r:i. 

-7:1: 7 5 r .1: ill .\ 5 ~z:~ 1 r 7.' r i 5 \ \ 7 .7. ". 7 1 ; . " 7;:" 7^77 

7.7 : :'rTr: ".:i:_: :1 7. :..::_. ':..:: 15 : 7zi:5: i7 7^: 17.7115 
are eia2T ami rapidly enured. Second degree: fe 
i-i : : 7:»:e5 : 7. 7 : - ; . : ~ : -_ : : 11 7 5 1 . . ". _ : 7 : : ; ~ :r .". 5 7_ 1 77i : t . 
and ftpimihnatFiSg as well as the fever, towards the seventh: many- 
are cured. Tiiiitd' degree: fever. eonmderahle fleliriur 
1.'- 1 : _ 1 : . 7 5 . : 1 : 177:1:7. 5 -: : : : -. : : 11. 11c : 7 11 .55.11 ; : :7 :. :;:. 
from the third to the fifth or sixth dayrver- 

i^l fa tamding the serious eharaeter of tfce third species, 

Tin pl i ^wW llM ji 11 Yff mn m i j !?■!■!, ii ■!■■■ rfTTII 
and i.\- about one-tlnrd were cured. In the year IX. mo re than 

:::.: "7:: :.::i 11 1 :i 5:111 : 7i 1-.511Z : 15 1711I7 :ii-i.7i* 
77 7 -:::::.: zi: - 5 11 1 -._:. 7 - 7 : . 11 5 :i 1: : "1 1 7 1: .1. 1 :;z - ?:i"t :-id 
peculiarly- Men addicted to ardent spirits and women were 
5-7 :n :::7. 

"The plague is evidently eonJagjmus, fait the conditions of the 

: : : 1 . : 1 1. : 1 : : 7... 5 : : 1 1: _ : 1 :: 1 : : : 11 : : 7 1 zi : 7 7 7 .1 : —7. 

7111 ::i 5i-;..i: 11777 77i 11.1: :oi:> 711:171777 ::n- 
wrnn^gato^ iit The body, while affiscted with febrile heat, and 

more readily. The river Kile was observed to be a barrier to 

tiii::7:-55 :: 1:7 711:771 A 5 ..:.:; 7 7::li mil 7i;'::i 1 
lizii. 17775177 ii= ::.~ 775- 111 :: — ii 157_7:1i7t 1: :.i : 15.7771- 
of this nature thai the French system of isolation, which 

'1 in 1 5: 1 1 ~ iz 1: 1 i : _ 5 . ~ .15 : : : 1 _ 7 1 . 
■■ I::~.:: 1 : ~ 1:7 _ 7 :.7 11 zzziizii zii 151 ::' 1 i.irz:7ir 
over the minds of men, I always refused 

. 1.1 :.:_.:.::: 11 7 11 ~ . 1 .1 it: H:>: 
to treat the whole army as a patient, to whom it 
-:~ : 17 ii:. 1117:7531:7. hi 11: r i:"7 : i'i " :__:.i_ 
:.: Tiirz: — iz :i:7.1 7 I1..5 7.51131. ~ zt: :: 15 ::' 1 vtrj :rlz:.7 



_:~7;75. 5ii:i:i ziz: .:.- ::::- ii-.zzz-iz .15-7 *:t 1 szzz: ii-i 
7 7^1171 . l:.:i:. ?zz- 77: 7 i:zzr ? 11 



i"-;<. .1 " :. 



THE PLAGUE. 359 

of the head, or an inclination to vomit, redness of the tongue, 
ardent heat and dryness of the skin, hardness and frequency of 
pulse. On the second or third day the inguinal glands were en- 
larged, with considerable pain. The bodies were in general 
marked with livid spots, particularly on the face and genital 
parts: many were perfectly gangrenous, and others without any 
external mark. Lavaresi opened three of the latter, and found 
the internal surface of the stomach and intestines covered with a 
yellowish mucus; the conglobate glands were very hard, but they 
had diminished considerably in size.* This physician was cer- 
tainly not much versed in this kind of researches. 

M. Larrey opened two bodies at Jaffa: the first, covered with 
petechias, exhaled a nauseating odour: the abdomen was meteo- 
rized; the great epiploon was yellow, and marked with gangre- 
nous spots, the intestines distended, and of a brownish colour; 
the stomach collapsed and gangrenous in several spots, corres- 
ponding to the pylorus; the liver of greater size than ordinary; 
the gall-bladder full of a black and fetid bile; the lungs of a dull 
white, variegated with black lines; the heart of a pale red, and 
easily torn; the auricles and ventricles were full of black and 
liquid blood; the bronchia containing a reddish and muddy fluid. 
In the second body, the derangements were nearly the same; the 
liver was more engorged, the gall-bladder enormously distended; 
the pericardium full of a bloody humour, and the cellular tissue 
exhibiting a net-work of varicose veins full of black and liquid 
blood. INI. Larrey remarked the same peculiarity in many other 
bodies which he opened in Egypt: circumstances did not permit 
him to open the cranium, t 

5. The plague which desolated Noja from the 23d of Novem- 
ber, 1815, to the 7th of June, 1816, affected 928 persons, in a 
population of 5615, and destroyed 716 persons: of these, 334 
were men, and 382 women; 623 poor, 3 rich, and ninety- 
tradesmen; 225 between the ages of one day and ten years, 157 
between eleven and twenty, 118 between twenty-one and thir- 
ty, 145 between thirty-one and fifty, 66 between fifty-one and 
seventy, and 5 between seventy-one and ninety; 309 died in the 
first three days, 302 from the third to the seventh, 73 from the 

* Essai sur la Topographie Physique et Medicale de Damiette dans l'His- 
toire Medicale de FArmee d'Orient, p. 89. 
f Mem. de Chir. Milit. Paris, 1812, in 8vo. p. 326. 



360 ?^T5I0IXMaCAL PY?.ETOU0fi¥. 

seventh to the fourteenth, 29 from the fourteenth to die thirty- 
eighth; 3 in November, 36 in December. 237 in January, 157 
in February, 144 in March. 52 m April, B 1 in May, and 6 in 
June. Seventy-eight died daring the same period without having 
presented symptoms of the plague. Thus, in the space of six 
months, 212 persons were cured; viz. 97 men and 115 women, 
155 poor, 10 rich, and 47 tradesmen; 37 from one day to ten 
years of age, 48 from eleven to twenty, 58 from twenty-one to 
thirty, 62 from thirty-one to fifty, and seven from fifty-one to 
seventy. Besides these, 546 persons were suspected of being 
affected, and were therefore watched. 

It was characterized by the following symptoms: prostration of 
strength, rigor, violent fever, with remission scarcely percepti- 
ble, headach, ardent thirst, extreme heat, pale, livid, or yellow- 
ish complexion, dilatation of the pupil, injection of the eves, 
tongue crimson in the centre, white at the edges, vomiting, 
worms, diarrhoea, malaise, anorexia, inability to retain nourish- 
ment, incoherent language, furious delirium, stammering, con- 
fusion of ideas, paralysis, apathy, entangled hair, dry and rough 
skin, hemorrhage, anthrax, buboes, petechia?, vibiees, miliary 
eruption, gangrene, sometimes sudden death. 

This plague was always attributed to a morbid, asthenic dia- 

The means employed were — water and vinegar, or lemon 
juice to the anthrax, until the falling of the eschar; afterwards 
the usual dressing of ordinary wounds; friction with oil over the 
buboes, cold effusions to the head in delirium; decoction of bark, 
internally, after some eccoprotics; acidulated drinks. Emetics, 
purgatives, nervines, antimonials, the mineral acids, anodynes, 
tie ;.::-i". ::/i.zTt. zz.iz r:s y:.i ~:.e:: .1:7 ~e:e ei"J:er UicLeis 
c : :. :z:: :.. 

The articulations of the dead bodies soon became flexible, and 
the limbs were supple. They presented, externally, large livid 
marks, where the parts of the body came in contact; the genital 
parts, the seat of the buboes and anthrax, and the circumference 
of the nose, were covered with marked spots of an obscure vio- 
let colour, with small whitish striae. On the 23d of March, the 
bodies of Felix Bueno, aged twenty years, and of Rose Lioce, 
zzti zr- vr;.:5. ••-:.; ].-i ezperieneei il! :':.- 5vz-.i:;z:s :: ::.- 
r- z± ■'"-: ' v — :7.'z-zi .:. ...e :r.;ii: ::' :lt :t::.e.e:v Tie lire-: 



run PLAGUE. 361 

cavities were examined with great care, and no morbid altera- 
tion of the viscera was discovered; every thing was natural. 

I confess it is very easy, while enjoying security, to censure 
those, who, surrounded with the horrors of the plague, had not 
sufficient resolution to devote themselves to the researches of 
pathological anatomy; I shall not, therefore, reproach MM. Ru- 
bino, Doleo, Garron and Perron: but it will be confessed that no 
positive conclusion can be deduced from two examinations so 
briefly reported, without any account of the symptoms present- 
ed by the subjects during life. We are bound, however, to con- 
cede the utmost praise to the care with which the tables of mor- 
tality, of which we have given a summary, were collected.* 

6. While the French army were in the Morea in 1828, M. 
Bobillier had an opportunity of observing the plague. Some 
Arabian slaves having brought the plague from Hydra to Argus, 
it was transported from the latter town to Vrachy by a retailer 
of clothes, who died of it. All who suffered from it contracted 
it by contagion. In all it developed itself by a gastro-encepha- 
lic irritation, the symptoms of which were those which have 
been pointed out by Chirac, Mertens, Bertrand and Desgenettes. 
In a single subject, the irritation of the brain appeared to pre- 
cede that of the other organs. In all, the buboes, anthrax, and 
carbuncle, supervened after the development of the gastro-ence- 
phalitis. Almost all the subjects perished: one hundred and 
sixty-one out of one hundred and sixty-four. 

If we institute a comparison between the typhus and the 
plague, we cannot but be struck by their surprising analogy. 
This marked analogy could not escape the observation of M. 
Desgenettes: who, in an immense and very crowded hospital, 
has seen an anthrax complicate the typhus fever, and impress 
upon it the character of pestilential fever. Since these diseases 
differ but little, since, as it regards the symptoms, there is no 
difference except in the frequency of buboes and anthrax in one 
and their rare occurrence in the other, are we not authorized to 

* Storia della Peste di Noja de Vitangelo, Morea. Naples, 1817, in 8vo. 
" La lingua presentava una cotenna formata de tre strisce, cremisi, al di 
mezzo, e biancastre a lati, sebbeni poi nel corso della malattia avese presen- 
tate altre variazioni essendo stata in alcuni biancastra ed in altri con simplici 
cotenna gialla (Doleo.) Lingua tremula, arida, giallognola ; o constrisce bi- 
ancastre a lati e rosso-fosche in mezzo (Rubino.") 

46 



362 PHYSIOLOGICAL PYEETOLOGY. 

conclude, that the plague is only the highest grade of a disease . ; 
which the typhus is one of the most dangerous aha : : . :nd of 
which the yellow fever is likewise a variety? 

To admit only a difference of intensity and of seat, between 
sporadic, adynamic and ataxic fevers, the typhus, the yellow fe- 
ver and the plague, is, I think, required by the knowledge we 
derive from the morbid phenomena. It is probable that this opi- 
nion would be supported by pathological anatomy in case a 
greater number of those destroyed by the plague were examined, 
and the organic alterations described with the accuracy which is 
exhibited at the present day in these researches. The researches 
of Soulier, Couzier, Deidier, and of M. Larrey, afford us a 
glimpse of such a result The purple spots mentioned by them 
were doubtless only patches, of a more or less deep red, which 
are found on the opening of dead bodies, after many adynamic 
and ataxic fevers. The internal and external carbuncles of the 
abdominal viscera were likewise only black patches circum- 
scribed or surrounded with an areola of deep red, which are of- 
ten observed on the internal surface or on the peritoneal surface 
of the stomach and intestines, and of which, not many days since, 
I observed a striking example, in a young officer to whom an 
emetic had been given in the commencement of gastritis. The 
red, black and gangrenous spots, the manifest effects of an in- 
flammation which only ceased with life, existed also in the lungs 
and several other organs in many of the subjects, a fact which 
points out an affinity between the plague and yellow fever: ex- 
cept that in the latter the black spots are less frequent than in 
the former. 

Considered then, in its symptoms and in the morbid traces 
impressed by it upon the organs, the plague is not a disease so 
different from other gr&~ : fevers, as not to have numerous points 
of resemblance; it may even be said that the points of resem- 
blance are more numerous than those of difference. This will 
completely explain the uncertainty of physicians with regard to 
t::.t :::::e c: ::s ccir-ir.er.cenrr.: :-.::.i ;he dlz:cul:y C'l'pclr-'.ir.g o:\i 
with accuracy the period of its cessation. 

After having investigated the only resemblances and diffe- 
rences by which we can distinguish between the plague and other 



THE PLAGUE. 363 

destructive fevers, I shall not farther seek, in the occult causes of 
these diseases, a reason for separating them or classing them to- 
gether. A sound physiology would teach us to study the cir- 
cumstances which hasten or retard the development of diseases, 
the phenomena which characterize them, the traces which they 
leave in the body, and the comparative results of the different 
methods of practice: an investigation of occult causes should he 
abandoned to men whose fertile imagination disdains the re- 
straints of cool reason. 

M. Le Chevalier de Butel has endeavoured to demonstrate, 
that Egypt is not the cradle of the plague, and that the one 
which ravaged it in 1791, was as evidently imported from Con- 
stantinople, as that of Marseilles was from Sidon.* But, must 
we believe, that the plague does not develop itself in Egypt but 
when it is brought from Constantinople? Certainly not; for if 
the plague originates at Constantinople from a contempt of the 
laws of Hygeia, this neglect is not less great in modern Egypt. 
Most of the Mahometan countries are subject to the plague; 
they reciprocally give and receive it: the same was the case in 
Europe before any sanitary measures were instituted. 



Treatment of the Plague. 

Since the plague seems to have developed itself in Europe, only 
in consequence of commercial relations with the east and Africa, 
until the contrary is clearly demonstrated, prudence imperiously 
demands the most scrupulous precautions in our lazarets; the in- 
terests of humanity are paramount to those of commerce. It 
is important, then, that every physician be penetrated with the 
precepts and examples given in the works of Diemerbroeck, of 
Cardinal Gastaldi, and M. Desgenettes. In their writings are 
found, not only an exposition of the precautions necessary against 
this scourge, but likewise an indication of those to which we 
must resort, when it declares itself notwithstanding these pre- 
ventive measures. Both are referrible to the general views which 
I have pointed out when upon the subject of typhus, with this dif- 
ference, that in typhus, it is less necessary to avoid the contact 

* Memoire sur le Peste, dans le Journ. Univ. des Sc. Med., xlie. vol. p. 5. 
Janvier, 1826. 



364 PHYSIOLOGICAL PYRETOLOGY. 

of patients, than the inspiration of the air which surrounds them, 
while it is necessary to avoid touching articles belonging to 
plague-patients as cautiously as the patients themselves. 

As long as the plague was attributed to a subtle poison, which 
being introduced into the human body, reached the heart and para- 
lyzed its action, it was natural to seek a mode of expelling this 
poison or of neutralizing its effects; on this account the strongest 
cordials were chosen, and especially those which were regarded 
as powerful sudorifics. It was the more readily believed, that to 
cure this disease it was necessary to expel it by the skin, as the 
appearance of buboes and carbuncles at the highest stage of the 
disease was regarded, not as a sign, but as the natural means of 
approaching recovery. What better course could be pursued, 
than to listen to the dictates of both nature and theory? Not- 
withstanding the innumerable deaths which attested at least the 
inefficacy of this method, it was as perseveringly followed as 
though it had been almost universally successful; it was, how- 
ever, perceived at last, that these cordials and sudorifics, so far 
from favouring, only embarrassed the operations of nature, and 
frequently to the great injury of the sick; that is to say, they 
died in greater numbers and more rapidly. The necessity was 
then recognised, of employing only the lightest cordials. The 
same was the case with regard to purgatives and emetics, employ- 
ed with the view of expelling the poison upwards and down- 
wards. Blood-letting, which was recommended by many phy- 
sicians, as a proper means of purifying the blood from this same 
poison, and of correcting the inflammatory and putrid disposition 
of this fluid, was copiously practised: but as it appeared very 
frequently to hasten death, it was at last abandoned. 

It appears, said J. B. Bertrand, that a disease of so extraor- 
dinary a nature, requires but few remedies, and generally those 
of a very simple and common character; a strict police, great 
care of the patients, and especially very prudent and attentive 
physicians. This physician neither rejected nor lauded any mea- 
sure: he endeavoured to turn to the advantage of the patient all 
the means afforded by pharmacy and surgery. However, it will 
be seen, that his method was not based upon the condition of the 
affected organs, although he laid down excellent principles inter- 
mingled with the most improper. 

He advised, that the abstraction of blood should never be co- 



THE PLAGUE. 365 

pious or frequent; that purgation should be gentle; that these 
measures should be resorted to only on the first day of the dis- 
ease, and not in an advanced state of the eruptions. If the pulse 
was full and strong and the headache violent, he abstracted six 
ounces of blood. He seldom repeated this measure. Afterwards, 
when the patient experienced nausea, he gave him tartar emetic; 
if of a full and robust habit, he purged with ipecacuanha: if he 
was delicate, he gave both tartar emetic and ipecacuanha, but in 
very small doses. If the tartar emetic only occasioned vomiting, 
he prescribed immediately after a gentle purgative, or a lave- 
ment. When the pulse was neither full nor elevated, he did 
not prescribe blood-letting, and he commenced the treatment by 
giving tartar emetic, always in small doses, provided this reme- 
dy was in the slightest degree indicated. If the patient was of 
a full habit, and one in whom much corruption of the primse 
viae might be suspected, he only gave a gentle purgative in a 
small dose, such as rhubarb, tamarinds, cassia, manna, syrup of 
roses. He purged no more in the course of the disease, provided 
it was not of prolonged duration, and provided the nausea did 
not continue after the emetic; for in the latter case he gave a 
purgative potion in small and repeated doses, until there had been 
two or three stools: after which, if the patient was prostrated 
and the pulse depressed, he prescribed a mild sudorific and alexi- 
teric, with which he always combined a small quantity of dias- 
cordium, to allay the effect of the purgative. He then recurred 
again to venesection, especially when there was delirium or stu- 
por or increased headache. The blood was taken from the foot. 
He prescribed at the same time simple emulsions, chicken water 
taken with moderation to prevent the too great relaxation of the 
belly; for, he remarked, it was always necessary to guard against 
diarrhoea in this disease. After the emetic or purgative, or at 
the commencement, when these means had not been indicated, 
if the pulse was very active, Bertrand prescribed toast and water 
acidulated; if the pulse was slow and feeble, he prescribed mild 
alexiterics until the tumours and carbuncles made their appear- 
ance. 

Strong narcotics threw the sick into a state of debility, from 
which they were with difficulty restored, into a fatal stupor, es- 
pecially when they were given at the decline. Bertrand em- 
ployed only the mildest articles of this class, and in small doses 



366 PHYSIOLOGICAL PYRETOLOGY. 

in case of delirium or violent agitation. Against the diarrhoea, 
he administered diascordium combined with absorbents; to coun- 
teract vomiting, he recommended diluents and the potion of Ri- 
viere: when the latter was suddenly arrested, colic and a burn- 
ing sensation of the intestines supervened, which only ceased 
with life. A copious diarrhoea, and that which arose from purga- 
tives was always fatal. Hemorrhage was sometimes followed by 
recovery. Sweats which had not been strongly solicited by me- 
dicine, were a favourable sign; when they supervened naturally, 
it was sufficient to administer, with the view of favouring them, 
sudorihcs of the mildest kind, such as the water of Centaurea be- 
nedicta, powder of viper, and lilium. The cardiac and alexite- 
ric medicines were useful, only when the prostration was extra- 
ordinary. When the oppression arose from engorgement of the 
chest, he recommended small bleedings; but when it was in con- 
sequence of the suppression of cutaneous transpiration, or of cold 
contracted by the patient, in uncovering himself, or was conse- 
quent on the recession of some external eruption, he administered 
mild sudorifics. Bertrand, hence inferred that it was necessary 
to cover the patients well, and he was persuaded of the utility 
of this practice, because he observed that those who had a slight 
moisture of the skin during the disease, almost always recovered. 
The regimen was that of acute diseases generally. 

The method pursued by Bertrand, is deserving of praise on 
many accounts. We perceive that this physician endeavoured 
to avoid the excess of Chirac in blood-letting, and the impru- 
dence exhibited by other physicians in the use of emetics, pur- 
gatives, sudorifics, and alexiterics; that his talents, by no means 
of an ordinary character, enabled him to remark, notwithstand- 
ing the theories of the schools, the bad effects of the last four 
measures, and that although he did not dare to proscribe them, 
he at least used them with great reserve. The same spirit of 
observation showed him that blood-letting was indicated in some 
cases; he therefore prescribed it, but this was at the commence- 
ment, and he was of opinion that it should not be abundant. 

M. Desgenettes recommended bleeding in the plague of Egypt 
when inflammation was very intense, and it was practised with 
success. 

For what reason did Bertrand administer tartar emetic and 
ipecacuanha at the same time, to persons of delicate constitu- 



THE PLAGUE. 367 

tions? Why did he resort to tartar emetic in almost every case, 
and to purgatives in all the others? This was, doubtless, in con- 
sequence of some prejudice of his medical education. We can- 
not be ignorant at the present day, why fever lights itself up 
afresh after the action of tartar emetic or a purgative, and if we 
admire the wisdom of the physician, who, under such circum- 
stances, repeated the abstraction of blood, we cannot but deplore 
the necessity which he had created. The drinks which he pre- 
scribed were most proper, but why did he fear lest they should 
induce diarrhoea by relaxing too much the abdomen? At least 
it is not difficult to believe him, when he says that diarrhoea was 
always to be apprehended; that after vomiting and purging, the 
weakness increased as well as the smallness of the pulse, and 
that mild alexiterics were probably but little adapted to the 
state of the digestive passages. Narcotics are, at the present day, 
justly banished from the treatment of delirium; we know that 
the diascordium, sometimes only suspends diarrhoea to make it 
reappear afterwards, in a more violent form; we know too, why 
acute pain in the abdomen supervenes when this medicine sud- 
denly suppresses diarrhoea: it is well known at the present day, 
that this pretended calmant, arrests diarrhoea only by augment- 
ing the irritation of the intestinal mucous membrane. 

It would be difficult to tell what difference Bertrand could 
perceive between oppression caused by engorgement of the chest, 
and that which, according to him, was caused by the suppression 
of perspiration, or by the sudden chilling of the body. In a dis- 
ease which leaves after death, very frequent traces of inflamma- 
tion, we are disposed to believe that it might be useful to pre- 
serve the patients from cold; and we may also readily believe, 
that when oppression is accompanied with signs which denote in- 
flammation of the lung, bleeding prescribed with less reserve, 
might not be without advantage. 

The local treatment of the plague, that is, the treatment re- 
quired by the buboes and anthrax, are not unimportant. Ber- 
trand reprobates the practice, equally barbarous and dangerous, 
of extirpation. 

M. Larrey applied cataplasms of squills, roasted in the ashes, 
to accelerate inflammation and induce the formation of pus. 
Without waiting their maturation, he opened them with the 
knife. When they were indolent and without any change in the 



368 PHYSIOLOGICAL PYRETOLOGY. 

colour of the skin, he employed the actual cautery, and imme- 
diately after a cataplasm. This means, which provoked inflam- 
mation and suppuration, appeared to him to contribute to the 
cure: he preferred it to caustic potash, the action of which is 
slower. He covered the carbuncles with hot and rubefacient 
cataplasms, he scarified them, cauterized them with corrosive li- 
quids, and removed the gangrenous parts with the knife. He 
thought, I know not for what reason, that the dressings of the 
buboes should not only be simple and suppurative, but tonic 
also. 

The efficacy of friction with ice, which was reported by Sa- 
moilowitz, being founded only upon three cases, in which too 
this author employed a number of other means, we must await 
the result of more extended observation, before we pronounce on 
its utility. 

Some facts seem to favour the belief that friction with warm 
olive oil may afford protection against the plague, and even that 
it has sometimes been efficacious in the treatment of this dis- 
ease.* 

"The indications," says Cullen, "to be fulfilled in the cure 
of plague, are the same as in fevers generally." The plague 
only appearing at distant intervals in Europe, physicians cannot 
do better than conform to this principle in the treatment of the 
disease. Far from obeying the pusillanimous advice of Galen, 
and imitating the timidity of Sydenham, let us always remem- 
ber this sentiment of Diemerbroeck: M Quapropter dico e locis 
pestilentia infestatis, cuilibet fugere licere, exceptis eis, qui spe- 
ciali officio proximis et reipublicas sunt devincti: quales sunt ma- 
gistrate, verbi divini ministri, medici, chirurgi, obstetrices, 
alique similes, quos pietas fugere vetat et quorum opera respub- 
lica tali imprimis tempore carere nequit." 

* Hiitoire Medicate de l'Armee d'Orient. 2d edit. p. 36. Paris, 1S30. 



QUARANTINE. 369 



CHAPTER X. 

Of Quarantine. 

When treating of typhus, the yellow fever, and plague, we 
spoke of the propagation of these diseases, and of the measures 
to be taken in consequence. But there is a point of the highest 
moment, common to these diseases, which merits special atten- 
tion: that of quarantine. 

Among the diseases which ravage our population, there are 
some which are considered as imported from distant countries, 
because they appear without manifest local causes, and after com- 
munication with the countries in which they frequently prevail. 
These diseases have been called contagious, from a comparison 
with those affections which are evidently the result of contact: 
they should be, and doubtless will ultimately be, named, im- 
portable; because this word presents clearly the idea of the fact 
which necessitates our precautionary measures, without any re- 
ference to the manner in which the communication of the dis- 
ease takes place. Thus, we shall designate by the name of im- 
portable diseases, those which are, or appear to be, capable of 
passing from one country to another, through the medium of 
persons and things. 

The variola, the venereal disease, and the itch, for example, 
are manifestly importable ; and yet no preventive measures are 
instituted against them. Yet the first is often of most fatal cha- 
racter, the second, one of the most cruel scourges of humanity, 
and the third, one of the most disgusting affections. But the va- 
riola, although capable of being imported, develops itself among 
ourselves, without having been imported. Long habit has to a 
certain degree familiarized us to venereal diseases, because they 
do not often prove fatal; and the itch is nearly confined to the 
; lower orders. The variola has, moreover, found in vaccination 
i an adversary, the efficacy of which renders preventive measures 

47 



370 PHYSIOLOGICAL PYRETOLOGY. 

still less necessary. Venereal diseases could not be made the 
objects of legislative enactment without rendering necessary the 
most disgusting investigations. 

It is desirable, that every traveller, soldier, and sailor, who, 
on entering the frontiers of our territory, either by sea or by 
land, is affected with the small pox, should be treated in a hos- 
pital, until properly cured. With regard to venereal diseases, 
this measure could not be enforced, except in the case of sol- 
diers and sailors, and among them it is enforced, wherever the 
officers are deeply sensible of their duties, not only to the state, 
but also to their fellow citizens. 

Although scarcely any thing is done to prevent the introduc- 
tion of diseases, manifestly importable, yet much is done to pre- 
vent that of diseases of which the importable character is not so 
clearly demonstrated.* 

Whence is it that in cases in which the necessity is not clear, 
the whole power of the institutions of the country has been em- 
ployed, while there has been complete inaction in cases which 
admit of no doubt? The cause, no doubt, of this difference in 
the government, is to be found in the effects of the diseases 
which have been the objects of their legislative enactments. 
However destructive may be the variola, however dreadful the 
venereal disease, and however disgusting the itch, they cannot 
be compared to those diseases which desolate whole towns and 
provinces, and sweep away one-fourth of the population. The 
greatness of the danger has awakened attention: thus, the vio- 
lence of the disease has given strength to the suspicion of its 
importability, and the government, the interposition of which 
was invoked by the public voice, could not await, and indeed 
ought not to have awaited, the slow result of methodical obser- 
vation. Quarantine has, therefore, been established by law: 
and the diseases against which it has been established, have 
ceased to appear where they formerly developed themselves 
with extreme violence. 

Is all the good effected by quarantine which is attributed to 
it? Could it effect more? Does not the system of quarantine pre- 

* No one is more inimical than I am to neologism, when without utility: 
but, whenever it is necessary to fix the attention upon a fact, it is proper to 
designate it by a special word, which is conformable to the genius of the lan- 
guage, and which recalls it most distinctly. 



QUARANTINE. 371 

sent abuses, which might be corrected without diminishing its 
utility? Is it susceptible of advantageous modifications? Such 
are the important questions to which the attention of the friends 
of humanity and science should be directed, and which I can 
onJy glance at. It is much to be wished, that a complete work 
should be published upon this important subject. 

Quarantine has preserved France from the importation of the 
plague: this seems a matter of certainty. It is a fact, however, 
that the plague desolated Marseilles, although the quarantine 
laws were in operation; but who does not know that the best in- 
stitutions may suffer from a relaxation of discipline? Moreover, 
the principles upon which quarantine is based, are not unmixed 
with hypothesis, and it is not certain that they are of such a 
character as to produce the greatest possible good. If it be the 
fact, as is believed by many, that some regulations respected 
solely for their antiquity, absorb the attention which might be 
more usefully bestowed upon other points, might not quarantine 
become at the same time less inconvenient, and more effica- 
cious? 

Has the quarantine preserved France from the yellow fever? 
This disease, fortunately having never reigned epidemically in 
our country, it cannot be decided whether we have been pre- 
served by quarantine, or by circumstances independent of all hu- 
man intervention. Before, and since the establishment of qua- 
rantine in France, the plague prevailed in the southern pro- 
vinces: before and since its establishment, the yellow fever has 
not appeared, although the communication has been frequent be- 
tween the ports of Spain and France. 

Has quarantine preserved France from the importation of ty- 
phus? We are in want of facts to enable us to pronounce upon 
this point: it is not generally by sea that communication exists 
with those countries in which this disease prevails. It has only 
been brought among us in the train of our armies, and convoys 
of prisoners, or it has developed itself in crowded hospitals. 
The typhus of the ships which ravaged Brest, was a melancho- 
ly exception: such was the malignity of the disease, that it bM 
defiance to every barrier. 

The infrequency of the lepra is not owing to quarantine regu- 
lations; for by this name formerly were designated a number of 
diseases of the skin, which have since received other names. 



372 PHYSIOLOGICAL PYRETOLOGY. 

and the lepra itself still exists or the coasts of the Mediterra- 
nean. It has disappeared only as civilization has advanced. 

It is only at the present day that the Indian cholera is classed 
among diseases, which should be made the objects of quarantine 
regulations: as it respects France, the quarantine regulations with 
regard to this disease, arose from an excessive precaution, in- 
spired by excessive fear. 

Let us not entertain the absurd notion, that every disease 
which rages in a neighbouring country is importable: it is enough 
that the magic name of contagion is incessantly repeated, even 
in our villages, on the occasion of the slightest disease, by busy 
bodies, who every day invoke epidemics in expectation of the 
benefactions of Artaxerxes. 

The plague of the east, the yellow fever, the typhus of camps, 
hospitals, and ships, the lepra and cholera of India, are the dis- 
eases against the importation of which quarantine is established; 
these diseases being, it is said, if not always, at least very often, 
contagious. This assertion is not too strong, perhaps it is not 
strong enough, when applied to the plague: but with regard 
to the yellow fever, it certainly exceeds the lessons of experi- 
ence; more is asserted than our positive information with regard 
to typhus justifies; and the importability of the cholera into 
France is assumed gratuitously. When it is asserted, that i£ it 
does not appear that leprosy can be transmitted by merchandise," 
it may be asked, are articles of merchandise more frequently 
touched by those who are confined to their beds by the plague, 
yellow fever* and typhus, than by the leprous? 

It is manifest, that in France the leprosy and cholera morbus 
should be immediately rejected from the number of diseases 
subjected to quarantine regulations. 

To suppress the sanitary laws directed against the plague, 
would be wantonly to expose the country to all the calamities of 
the plague of Marseilles. 

With regard to typhus fever, the interests of the population 
of the ports, rather than of the interior, requires the separation 
o£ persons arriving with this disease, the exposure to the air of 
articles which have been about them, and the disinfecting of the 
vessels in which they arrived. 

The great question of the yellow fever is undecided: yet the 
labour of M. Chervin, the report made to the Royal Academy 



QUARANTINE. 373 

of Sciences, and that which has been sanctioned by the Royal 
Academy of Medicine, induce us to think that the non-conta- 
gion of this disease will soon be admitted as an established fact, 
by a great majority of the physicians of the two worlds. The 
yellow fever will then no longer be regarded as the object of 
quarantine regulations. Until then, these safeguards of the pub- 
lic health should be respected. It is, however, proper to inquire 
whether the administration of quarantine could not be improved. 

The symptoms of the plague, those of typhus, and of yellow fe- 
ver, have been laid down in a system of instructions, which are 
to serve as a guide in the application of the sanitary laws. 

The symptoms of the plague are pointed out with a degree of 
precision, which leaves no room for error. A single page com- 
prises the whole description. We think it may properly be in- 
troduced in this place. 

" The signs of the plague of the east, are a continued fever, 
animated face, and injected eyes: frequently a stupid air, and a 
sense of general torpor; in walking, the step is doubtful, and of- 
ten staggering; difficulty of combining ideas, the fixity upon 
some particular object, which is generally one of terror: men 
noted for their contempt of danger become most pusillanimous. 
The symptoms which have been enumerated, whether isolated 
or united, are still equivocal and common to other diseases. The 
positive or indubitable signs of plague, are the following: 1st, 
Buboes in the groin, in the arm-pits, in the angles of the jaws, 
conjoined with all, or with some of the symptoms which have 
been mentioned; 2dly, Pestilential anthrax or carbuncle, pete- 
chias, which are superficial spots, at first red, afterwards black, 
more or less extended, distinct or confluent, on different parts of 
the body, and especially upon the neck, the anterior parts of 
the chest, and the friferior extremities; 3dly, To the symptoms 
above enumerated, whether all, or only a part of them occur, is 
often joined, (and nothing is more dangerous,) a high degree of 
delirium, accompanied by fever of a very ardent character, and 
very abundant sweats always inducing a debility which gradu- 
ally extinguishes life. The plague continues seven or nine days, 
and seldom fourteen days. Sometimes it lasts only a few hours, 
and men fall down dead who were not supposed to have been 
affected. Under these circumstances, they present no apprecia- 
ble symptoms of the plague, and their death is generally occa- 



374 PHYSIOLOGICAL PYRETOLOGY. 

sioned by apoplexy or internal hemorrhage, which some obser- 
vations permit us to attribute to the destruction of the large 
vessels, attacked by carbuncles occurring over their course, M 

Here is nothing vague and indeterminate; the insufficiency of 
the common signs are pointed out; they are not dwelt upon, and 
they are not given as sufficient reasons for the enforcement of 
quarantine. For what reason should the phenomena be more 
amply detailed, which, instead of removing uncertainty, occa- 
sion it? Would it have been wise to assign them as motives 
proper to decide the necessity of so important a measure as the 
performance of quarantine? 

With regard to the yellow fever, a different course has been 
pursued; the signs of this disease are divided into two classes: 
the one class, which consists of such as lead to a suspicion of 
yellow fever, and which should occasion a probationary quaran- 
tine, are; u Sudden and violent accession of fever, without pre- 
cursory symptoms, commencing with a rigor of considerable du- 
ration; acute and obstinate internal pain, fixed in the forehead; 
insomnolence, or frightful dreams, if there is somnolence; red- 
ness of the balls of the eyes; air of inquietude, affright and asto- 
nishment; tongue red at its edges and at its point, but covered 
on its middle with a white or slightly yellow coating, often very 
dry towards the termination of the disease; frequent attempts to 
vomit; acute pain in the stomach; lacerating pains of the kid- 
neys; difficult respiration; frequent sighs; pulse at first hard and 
strong, returning in the middle period of the disease to a state 
nearly natural, and terminating by being small and excessively 
weak; in some patients, spots; petechias; in others, large brown 
patches, especially at the approach of death; three distinct pe- 
riods in the course of the disease, characterized in the following 
manner: the first, by an acute irritation, continuing from two to 
three days; the second, by a deceptive calm, lasting from twen- 
ty-four to thirty-six hours; the third, by all the symptoms which 
announce trouble and disorder in the functions: it generally con- 
tinues from the fifth to the seventh day. In the first period, the 
face is animated, often very red; in the second, it is pale; in the 
third, it is of a decided yellow colour. When its course is more 
rapid, the periods are confounded, and the patients die on the 
second, third, or fourth day: the usual duration, however, of the 
fever is from fire to seven days. 



QUARANTINE. 375 

From this exposition, it manifestly appears that a ship, on 
board of which is found any sick person, should be suspected 
of baying the yellow fever, and therefore obliged to undergo a 
probationary quarantine. In fact, there is not a single acute dis- 
ease which may not exhibit some one of these characters. In 
all acute diseases the accession may be sudden and violent, and 
announced by a rigor; the forehead may be painful, there may 
be insomnolence, or the sleep may be troubled with dreams, or 
there may be very marked somnolence; the conjunctiva may 
be red, the countenance anxious, the tongue red upon its edges 
and at its point, covered with a white yellow coating in the cen- 
tre, very dry at the termination of the disease; in all there may 
be frequent retchings, pains in the stomach and lumbar regions, 
embarrassed respiration and frequent sighing. The pulse, at 
first, hard and strong, then almost natural, is necessarily small 
and weak on the approach of the fatal termination. Spots which 
are not described, should not be laid down as characteristic signs 
Petechias do not belong to the yellow fever. Large and brown 
spots are not uncommon in other diseases of seamen. 

The three periods of yellow fever are an unequivocal sign of 
its presence, according to many physicians who have seen it; 
they are, however, ranged here among signs of mere probability 
— and are mingled with signs of sojnsignificant a character, that 
we cannot explain how men of intelligence could give them as 
reasons for suspecting the existence of a disease which should 
render quarantine necessary. The yellow colour of the skin, 
from which as being the most conspicuous phenomenon, the dis- 
ease has derived its name, is found inappropriately placed among 
symptoms common to all diseases; but farther on, we find it 
among the unequivocal symptoms: the description is vague and 
dangerous, and betrays a singular want of clearness in the ideas 
of the persons who dictated this part of the instructions. It is 
evident, that in giving this exposition of the symptoms which 
should lead to the suspicion of yellow fever, it was thought ne- 
cessary to compose a piece of nosology, in which every thing 
should be said, while all that was necessary was a medical docu- 
ment, in which that alone should find a place, which might be 
essential in the administration of quarantine. It has not been 
perceived that in consequence of this minute enumeration of 
symptoms, which, with two exceptions, belong no more to the 



376 PHYSIOLOGICAL PYRETOLOGY. 

yellow fever than to any other disease, every subject affected with 
cerebral and pulmonary congestion, and with gastro-intestirial ir- 
ritation, should be suspected on his arrival in port. The suspi- 
cion would be greater, if he died during the passage. Ac- 
cording to these instructions, it is sufficient cause for the qua- 
rantine of a vessel, that a sailor dying after an illness of a few 
days, during a voyage, should have had, in the course of his 
disease, injected eyes, retching and spots which might be scor- 
butic. 

But it may be said that it is desirable that such a result 
should be produced by the code of instruction, since the country 
will by this means, be infallibly preserved from this scourge. 
Such should not be the language of science, nor such the plan of 
sanitary administration; exaggeration subserves the cause of nei- 
ther justice nor prudence. If it be deemed proper, that every 
ship, on board of which a single death occurs, should be sent 
into quarantine, it would be sufficient to lay down this regula- 
tion; there would be no need of these detailed instructions. Or 
let the law go still farther, and order a rigorous quarantine for 
every vessel at every period. But if, from a regard to prudence 
and a proper respect for the liberty of individuals, it is desired 
to enforce this measure only when it is necessary, let the cir- 
cumstances which necessitate it be clearly laid down. By in- 
creasing the inconvenience of sanitary regulations, the tempta- 
tion to evade them becomes greater; to give efficacy to the laws, 
they must be laid down with precision — a power which is vague 
and undefined loses its influence or becomes insupportable. 

The symptoms, pointed out in the instructions as indicating 
the real presence of yellow fever, and as requiring the enforce- 
ment of rigorous quarantine, present no uncertainty: " Discharge 
of blood more or less copiously by the mouth or anus; the blood, 
likewise, sometimes escapes by other orifices; evacuations of mat- 
ters, having generally the colour of coffee-grounds, and some- 
times black; they are discharged by the mouth, the anus, or the 
bladder; jaundice, which may be confined to the eye-balls or to 
the face, or which may extend over the whole body; suppression 
of urine. 

We percewe, that the yellow colour of the skin is presented 
both among the certain and uncertain signs: this is faulty. As 
to the suppression of the urine, it is enough to have seen fevers 






QUARANTINE. 377 

of a grave character, of whatever nature, to be convinced that 
it is not a special sign of yellow fever, although it is a very fre- 
quent one in this disease. 

There is no doubt but that the cases have been unnecessarily 
multiplied in which a quarantine of observation is required on 
account of a suspicion of yellow fever: even should the contagion 
of this disease be admitted, it is certain that the part of the in- 
structions which relate to the doubtful signs of this disease, should 
be revised. 

In typhus, the doubtful signs are not distinguished from those 
which are certain: whence we may conclude, that this part of 
the instruction, which should be uniform and consistent through- 
out, is the work of different hands. 

"At the accession, lassitude, interrupted sleep, trembling of 
the hands, stupor, fever; acrid and biting heat of the skin, ver- 
tigo, head heavy, and, as it were, in a state of drunkenness; ani- 
mated countenance, signs of pulmonary catarrh. Pulse, at first 
active, full, hard, and afterwards embarrassed, obscure, unequal; 
tongue at first white or yellow, afterwards acrid, hard, trembling, 
retracted, black; eyes brilliant in the commencement, afterwards 
dull and bordered with hardened rheum; lips and teeth covered 
with a blackish cqating: on the fourth day the appearance of a 
purple or marbled exanthem, or of petechiae or inflammation of 
the parotid glands. Afterwards, prostration of strength, trem- 
bling of the limbs, of the lower jaw, subsultus tendinum, weak- 
ened vision, deafness, disturbance of the intellectual faculties; 
wild and frightful dreams, delirium, sometimes a fixed and pre- 
dominant idea; abdomen painful and distended; offensive breath, 
cold sweats, having the odour of mice; fetid liquid dejections, 
which are sometimes bloody, involuntary, cadaverous; nasal he- 
morrhage, sometimes gangrenous eschars, seldom buboes; urine 
at first red, scanty, burning, sometimes suppressed, towards the 
termination abundant, turbid, sometimes involuntary. An acute 
disease, which comes to a crisis from the seventh to the four- 
teenth day by the urine, sweat, stools, hemorrhages, sputa, sali- 
vation, often fatal, particularly among great collections of men; 
it is then eminently contagious, and rapidly fatal. 

Much might be said on the subject of this collection of signs, 
some of which are common to all fatal diseases, and others of 
little importance. At least no classification of them has been 

48 



378 PHYSIOLOGICAL PYRETOLOGY. 

attempted: the appreciation of their importance is left to profes- 
sional men, to whose memory they are recalled, and who are not 
obliged to declare from a literal construction of the instruc- 
tions, that there is suspicion, when they do not conscientiously 
think so. 

Should men, unacquainted with medical science, be called upon 
to pronounce with regard to sanitary measures by the aid of these 
tables of diagnosis, the impropriety would be still more marked, 
of laying down signs without any real value, which, to minds 
operated upon by a very excusable fear, would appear of formi- 
dable importance. 

The vague character of the instructions relative to acute diseases, 
deemed contagious, and the special importance erroneously attri- 
buted to symptoms common to other diseases, would frequently 
have the effect of classing ships not only under the patenie brute, 
but also under the patente suspecte* and in consequence thequa- 
rantine of rigour appointed in both cases would be enforced. 

This quarantine on the shores of the ocean, and of the British 
Channel, is from five to twenty days for the patente suspecte, 
and from ten to thirty days for the patente brute. On the coasts 
of the Mediterranean, and on the frontiers in the interior, from 
ten to thirty days for the patente suspecte, and from fifteen to 
forty days for the patente brute. 

Let it be remarked, that on the northern and western coast of 
France, a vessel carrying the patente suspecte, is in certain 
cases subjected to a quarantine of twenty days, while a vessel 
with the patente brute may only perform a quarantine of only ten 
days. In the same manner, on the coasts of the Mediterranean, 
the first may perform a quarantine of thirty days, while the se- 
cond is released in half this period. 

* With a view to ascertain the propriety in each case, of a more or less rigo- 
rous quarantine, letters patent are given by the consuls of the different ports, 
indicating the circumstances under which the vessel sails in relation to conta- 
gious diseases. The patente nette declares, that the vessel is entirely free 
from the suspicion of any contagious or infectious disease. 

The patente suspecte declares the existence in the country, of a disease of 
a malignant character, which is communicable and is suspected of being 
pestilential, or it declares that there is a free communication with the cara- 
vans arriving from places in which the plague or yellow fever is prevailing. 

The patente brute declares, that a contagious disease rages in the country 
from which the vessel sails, or in the neighbourhood, and that merchandise 
from this country forms part of the cargo.— (Trans.) 



QUARANTINE, 379 

It is impossible to assign a reasonable motive for so singular 
a difference. It is manifest that the quarantine should always 
he longer in the case of a convicted vessel than when there is 
doubt. This manifest contradiction exposes the want of facts 
upon which a proper decision might have been founded. There 
is also a deplorable defect of logic, or rather routine has tri- 
umphed over the intelligence of the distinguished men who were 
consulted by the authorities. 

The quarantine of rigour has for its object " to subject 
merchandise to the purification necessary for the destruction of 
the germs of contagion with which it may be infected." 

This is to pursueva retrograde march towards the infancy of 
science, when it was believed that aromatic vapours had the power 
of neutralizing the deleterious action of putrid miasms. The 
same erroneous mode of reasoning was extended to corpuscles 
inappreciable to the senses, and these fumigations were thought 
capable of destroying pestilential miasms. 

Aromatic fumigations are of no utility; the future alone must 
decide with regard to the power so greatly exaggerated of the 
chlorurets: but, above all, the persons and things suspected should 
be exposed thoroughly to the action of air and water; the former 
should, as far as possible, be exempted from a wearisome con- 
finement, the inconveniences of necessary seclusion should be 
alleviated by all possible means, and the customary ridiculous 
fumigations should be banished. 

It may be objected, that precautions in reality useless, might 
become useful by their moral influence: to produce this effect, 
however, it would be necessary that persons performing quaran- 
tine, should be convinced of its necessity and of the utility of 
the fumigations; now it does not appear that upon these two 
points public opinion has manifested a spirit of great docility. 

If a ship carries a patente nette declaring that the crew and pas- 
sengers were in good health at the moment of departure; that in 
the country from which they sailed the public health was good; 
that there existed no suspicion of pestilential disease, or that a 
pestilential disease which had prevailed had ceased for more than 
forty days; that in the neighbouring countries and in those with 
which there was a free communication, there was no suspicion 
of pestilential disease; that the countries, which had furnished 
the cargo of the vessel, were likewise free from all suspicion; if, 



380 PHYSIOLOGICAL PYRETOLOGY. 

farthermore, the crew and the passengers are in good health on 
their arrival; if, when there have been diseases on board, these 
diseases have presented no suspicion of contagion, or have ceased 
for more than forty days; if, during the voyage, the ship has not 
touched at any suspected or infected port; if there has been no 
contact with suspected or contagious merchandise; if the sanita- 
ry department have received no intelligence announcing the ap- 
pearance of some contagious or doubtful disease in the country 
of departure; if, finally, the papers on board are in due form; if 
it is evident that there has been no alteration with the view of 
concealing the truth; if all questions are satisfactorily answered, 
and there are sufficient reasons for confidence and security, you 
would doubtless believe that the vessel would be admitted with- 
out difficulty; this, however, is by no means the case: this ship, 
with the crew and cargo, maybe subjected to a quarantine of ob- 
servation, lasting from two to five days: that is to say, a ship 
which there is no reason to suspect, may be treated in the same 
manner as a ship which has had communication with places, per- 
sons or things infected with contagion; nor is it indicated under 
what circumstances the patente nette shall have its full effect. 

A French ship coming from Martinico arrives at Cadiz, and 
being examined with care, is pronounced free from suspicion: 
after live days, she sails for France, and on arriving in one of 
our ports is condemned to a quarantine of twenty days, as though 
she had come directly from Martinico. 

This distinction of the patent into nette and brute, is evi- 
dently only a cloak for arbitrary power: the only distinction of 
vessels should be into healthy, suspected and convicted; the 
first, free immediately after examination; the second, subjected 
to a probationary quarantine for a space of time proportioned to 
probability of its infection; the third, subjected to isolation, the 
action of the air and water during the time deemed necessary in 
each case. 

The term of forty days is not less arbitrary than any other: it 
is also necessary to extend it, when, during this time, pestilen- 
tial diseases manifest themselves in the vessels in quarantine: in 
such cases every latitude is allowed to the sanitary authorities. 
"What advantage, then, can be derived from laying down so com- 
plicated a system, and one which renders ships, which are not 
suspected, liable to a quarantine longer than that prescribed for 
infected ships? 



QUARANTINE. 381 

The truth is that the law cannot, and therefore should not, at- 
tempt to provide specially for every case: when, however, it 
attempts to descend to details, it should leave nothing to the ar- 
bitrary will of the executive, otherwise it opens a door to ca- 
price, routine and error. 

Brief as these remarks have been, they suffice to demonstrate 
that our sanitary administration is not free from every objection 
in the principles of its application, and independently of all con- 
troversy with regard to its utility, which is incontestable in cer- 
tain cases. — To glance at such a subject, is to perform but weakly 
a task which, doubtless, will be accomplished by some one 
having a better opportunity of observing the defects of quarantine, 
and of greater ability in exposing them, but not by one more alive 
to the interests of truth, which are ultimately those of huma- 
nity also. 

The person who shall undertake this useful task should be 
careful to show that the principles of quarantine adopted in the 
ease of plague, even should their propriety be fully admitted, 
should not be rigorously applied in the case of yellow fever, but 
should be modified by the comparative remoteness of the places 
from which there is danger of importation. 

In a certain part of France, which could be named, quarantine 
is perfectly illusory. The time may perhaps arrive when in- 
stead of placing vessels in the basins to stagnate, they will be 
subjected to a rigid inspection, and the owners compelled to 
be less economical in their repairs. Then the suspected vessels 
will not be those alone which have sick persons on board, or 
which come from places in which the yellow fever prevails, but 
all those which in consequence of neglect are greatly out of re- 
pair. Ships will then go into quarantine not to rot, but to be 
rendered sound. 



382 PHYSIOLOGICAL PYRETOLOGY. 



CHAPTER XI. 



Of Intermittent Fever, and particularly of Benign Inter- 
mittent Fever. 



When Pinel reduced intermittent with continued fevers to a 
limited number of orders, in the establishment of which he paid 
no regard to the type, the eminent service he was rendering to 
pathology was not properly appreciated. At the present day 
many physicians are more than ever opposed to his opinion; 
some influenced by the hope of finding in the history of inter- 
mittent fevers arguments against the new theory of fevers in 
general, others desirous of excusing their adherence to the new 
doctrines, as far as regards continued fevers. Some timid par- 
tisans of the new doctrines, are embarrassed when they are asked 
whether they admit of an easy application to periodical fevers: 
these are matters which determine me to treat particularly of 
these diseases. 

Thus far I have not given the treatment of each of the con- 
tinued fevers, until after an investigation of their nature and seat, 
their symptoms, causes and organic alterations: but the ideas ge- 
nerally entertained with regard to the nature of intermittent 
fever, are too intimately allied to their treatment, to permit me 
to pursue the same course. I shall therefore give the pathologi- 
cal and therapeutic history of these fevers, as it is found in the 
works which have hitherto been published upon the subject; I 
shall investigate their nature and seat; I shall then inquire whe- 
ther it be possible to render less empirical a mode of treatment, 
the efficacy of which, in most cases, if not in all, is demonstrated 
by experience. 

It appears that it has not been thought enough to attach more 



INTERMITTENT FEVER. 383 

importance to the type of intermittent fever than to their symp- 
toms, since most pyretologists have gone so far as to describe in 
the abstract a regit htr intermittent fever, simple or legitimate, 
which, according to the judicious remark of Pinel, is never met 
with in practice, Boerhaave, Stoll and authors of the present 
day who have copied them, describe it in the following man- 
ner: — 

" It commences with yawning, pandiculation, lassitude, weak- 
ness, coldness, rigor, trembling, paleness, lividity of the extre- 
mities, difficult respiration, anxiety, nausea, vomiting, frequent 
pulse, sometimes more slow, feeble, small; excessive thirst; the 
skin covered with small miliary elevations, sometimes of a livid 
or purple colour; urine scanty and watery; frequently crying 
and convulsions in infants. This is the first or cold stage. 
The hot stage presents the following symptoms. Heat and red- 
ness of tlie skin, respiration strong, large, and more free; less 
anxiety; pulse larger and stronger; great thirst; acute pain in the 
head and limbs; urine generally red. This is succeeded by the 
third or sweating stage. Remission of all the symptoms, abun- 
dant sweat, turbid urine with lateritious sediment, liquid and fe- 
tid dejections, sleep, apyrexy, lassitude, weakness/' 

These symptoms are those which are found in the greater 
number of intermittent fevers. Those symptoms have been 
omitted which do not generally manifest themselves. The se- 
ries of symptoms forms what is called a paroxysm, which is di- 
vided into three stages. 

The duration of the first stage is from a few minutes to half 
an hour, and sometimes even five or six hours. The second 
stage lasts from one to two hours; it may continue four or five 
hours. The third stage varies in duration, but it is generally 
shorter than the second. 

The paroxysm sometimes continues but an hour; generally 
from four to eight or twelve hours; seldom longer than from fif- 
teen to twenty-eight hours. 

The fever is called quotidian when it returns every day, when 
on alternate days, it is called tertian; when two days intervene 
between the paroxysms, it is called quartan. Quotidian parox- 
ysms, returning at different hours, or differing in intensity and 
duration, &c, but corresponding on alternate days, constitute 
double tertian. Two paroxysms, occurring within twenty-four 



384 PHYSIOLOGICAL PYRETOLOGY. 

hours, on alternate days, constitute doubled tertian, (tierce dou- 
blee.) The fever is triple when there are two paroxysms every 
other day, and one on the intervening day. A quadruple-tertian 
has been mentioned, characterized by two paroxysms every day. 
Paroxysms, occurring on the first and second day, and followed 
respectively by a paroxysm on the fourth day after, characterize 
the double quartan. Two paroxysms in a day, separated by an 
interval of two days, form the doubled quartan. Three parox- 
ysms every fourth day constitute the tripled quartan. Finally, 
a paroxysm every day, corresponding to that from which it is 
separated, by the intervention of two paroxysms, constitutes the 
triple quartan. A quotidian may be doubled, and even tripled. 
Some authors report a few instances of quintan, sextan, hebdo- 
medary, octan, nonan, decimal, quatuor-decimal, quin-decimal, 
mensual, bi-mensual, tri-mestrial, and annual intermittents. 
These species are so rare, that they can be regarded only as ex- 
ceptions to a general rule. It is more common for the parox- 
ysms to return at indeterminate periods ; constituting irregular, 
erratic, or atypic intermittent fever. 

The paroxysms generally occur in the morning in quotidian, 
at noon in tertian, and in the afternoon in quartan fever; their 
duration is longer in the first than in the second, and in the se- 
cond than in the third. The cold stage is shorter in the quoti- 
dian, and the heat is moist and of little intensity, and the thirst 
not so great as in the others. The cold stage is more prolonged 
in the quartan than in the quotidian, and less violent than in the 
tertian; the pulse is concentrated and deep, and the patient ex- 
periences a general sense of contusion; the heat is mild, but dry, 
and the sweat moderate. The cold stage is prolonged and in- 
tense, the patient suffers internally, the thirst is excessive, the 
heat is acrid, general, and of considerable intensity in the ter- 
tian. 

The tertian is the least obstinate of all; the quartan continues 
longer; the former terminates spontaneously after four, five, se- 
ven, or nine paroxysms; the latter frequently continues during 
months and years; the duration of the quotidian is a mean be- 
tween the other two. 

The tertian and quotidian most frequently appear in spring, 
and in adults of a sanguine or bilious temperament; the quartan 
is most frequent in autumn, in persons of tender age, in lympha- 



INTERMITTENT FEVER. 385 

tic constitutions, and in women. Spring frequently puts an end 
to an intermittent fever, to which autumn gave rise, and vice 
versa. 

The interval which separates the paroxysms. has received the 
name of apyrexia; in proportion to its duration, is the health 
of the patient between the paroxysms; consequently, the health 
is more perfect in the apyrexia of quartan fever than in that of 
tertian, and in the apyrexia of the latter, than in that of quoti- 
dians and double tertians. It is not, however, uncommon for 
the patients to remain weak and pale, to suffer from heaviness of 
the head, cold, want of appetite, and slowness of digestion, 
during the apyrexia! period. This state, which approaches that 
of disease, becomes gradually established, and augments in in- 
tensity as the fever becomes more ancient. The subject grows 
thin, becomes sallow, and weak; the liver, the mesenteric glands, 
and the spleen enlarge, the lungs become disorganized, the cel- 
lular tissue becomes infiltrated, and dropsy supervenes. 

Quotidian fevers are often observed to become continued, the 
tertian becomes quotidian, and the quartan becomes tertian; 
quartans and tertians, in some cases, terminate by assuming the 
continued type. All these fevers may alternate with each other; 
a fact which should not be forgotten, ^as it shows that the type 
is only a circumstance of a purely secondary nature. When 
the paroxysms of a quotidian fever, a double tertian, or a triple 
quartan, are so near each other, that one hardly terminates be- 
fore the other commences, this fever assumes the name of sub- 
intrant. It is often difficult to distinguish it from a continued 
fever, and the distinction is impossible, when the rigor is little 
marked, and there is scarcely any apyrexy. 

The paroxysms do not always return at equal intervals, espe- 
cially in the first period of the disease, as well as at its decline. 

Intermittent fevers, especially tertians, frequently cease spon- 
taneously; more frequently they are prolonged from one season 
to another; in certain situations they only cease to return on the 
following year, or even sooner. If, in the acute state, they are 
much less frequently fatal than continued fever, they gradually 
destroy the subject when their course is not arrested. 

Such is, in a general way, the history of the symptoms of 
these fevers. But they have not been considered only in rela- 
tion to their type. Those which manifest themselves in the 

49 



386 PHYSIOLOGICAL PYRETOLOGY. 

spring have received the name of vernal: that of autumnal has 
been given to those which show themselves in autumn, and this 
distinction appeared fundamental to Sydenham. They have been 
farther divided in,to exquisite or legitimate, and prolonged: into 
salubrious and insalubrious; into benign, which do not immedi- 
ately threaten the life of the subject, and into pernicious, which 
destroy him after a few paroxysms. The first of these divisions 
has not been without its utility, because it has shown that the 
intermittent fevers of spring generally present unequivocal in- 
flammatory symptoms; the second is purely scholastic; the third 
is founded upon erroneous opinion, viz. that fever may be the- 
rapeutic or curative; the fourth is eminently useful in practice, 
and it is on this account, that I have divided the history of in- 
termittents into two chapters. The word pernicious is impro- 
per, but it is sanctioned by use, and it would be inconvenient to 
reject it before a more suitable one has been substituted. 

Convinced that much less consideration is due to the type, 
than to what is called the character, that is to say the symptoms, 
Pinel, in bringing together intermittent and continued fevers, 
has divided the former as well as the latter, into inflammatory, 
gastric, mucous, adynamic, and ataxic — a luminous division, and 
of great utility in an investigation of the nature and seat of these 
fevers. 

1st, Inflammatory intermittent fevers have been observed by 
Sydenham, Pringle, Huxam, and Selle. M. Friseau has fur- 
nished striking instances which I regret cannot be given in this 
place.* If Pinel has reason to think that this name has been 
given to many intermittent gastric fevers, he does not show him- 
self consistent with his own principles, in not considering as in- 
flammatory, those intermittent fevers in the second stage of 
which the skin is red, hot, and halituous, the pulse large and 
full: fevers of this character are not uncommon in spring. Some- 
times, and most frequently, they depend upon an irritation of 
the stomac*h, of little intensity, characterized by thirst, and red- 
ness of the edges of the tongue. Sometimes they are caused by 
insolation, and, in that case, depend upon irritation of the ence- 
phalon, in which the digestive organs are more or less involved: 



* Recherches et Observations pour servir a l'Histoire des Fievres Inter- 
mittentes. Paris, 1803, in 8vo. 



INTERMITTENT FEVER. 387 

in this case, there is considerable heaviness of the head, the face 
is red, and the eye brilliant, especially in the second period. Fi- 
nally, they are sometimes determined in young girls and pletho- 
ric women, by a momentary irritation of the uterus; in young 
men intemperatcly addicted to venery, they may arise from a 
bronchial or pleuritic irritation, which may become the origin 
of pulmonary phthisis. In the latter case, the stomach is but 
little irritated, or not at all so. We should farther class among 
inflammatory intermittents, those which are observed in subjects, 
in whom the bladder has been irritated by the presence of a 
sound, or by retention of urine, arising from stricture of the 
urethra, and, likewise those which are produced by the action 
of mechanical causes operating on other parts of the abdominal 
viscera. 

Inflammatory intermittent fevers, generally tertian, sometimes 
quotidian, last but a short time, and are more frequently cured than 
the other types, without the interference of art, and never occa- 
sion very promptly the death of the patient: but they must not be 
abandoned to their natural course, because the causes which have 
produced them may occasion their continuance, and their transi- 
tion to the chronic state: now every prolonged disease should be 
prevented or cured, whenever this can be effected. 

2nd. Gastric intermittent fevers are the most common, and 
their analogy to continued gastric fever is most striking: they 
are generally tertian, double tertian, or quotidian, sometimes 
quartan, at other times, erratic. " The paroxysms occur," says 
Pinel, " most frequently in the morning, the rigor commences in 
the back, and is usually accompanied with general trembling: 
the pulse is weak and concentrated; there succeeds a heat which 
is acrid, dry and uniform over the whole surface, with intense 
thirst: the pulse is then frequent and 'developed, the face red 
and animated. The paroxysm terminates by a general sweat 
This fever ceases after three, five, or seven paroxysms; or it is 
frequently prolonged beyond this period." To these symptoms, 
Pinel should have added nausea and vomiting, which occur al- 
most constantly, the yellow colour surrounding the lips which 
often appears during the paroxysm, and which soon becomes ha- 
bitual, when the disease is prolonged. He omits the weight and 
pain in the epigastrium, because he had mentioned it when treat- 
ing of continued gastric fever, of which, according to him, the 



388 PHYSIOLOGICAL PYRETOLOGY. 

intermittent is only a variety. He has not mentioned the red- 
ness of the borders of the tongue, because he was not aware of 
the importance of this symptom, which, as well as the sensibi- 
lity to pressure of the epigastrium, is not less marked in the in- 
termittent gastric, than in the continued gastric fever. 

The intermittent gastric fever is often the consequence of the 
continued gastric fever, and it is not uncommon to see the 
former succeeded by the latter. Who then can deny the exist- 
ence of gastro-enteritis in the one, and assert it in the other 
case? 

The gastric intermittent is more serious than the inflammatory 
intermittent fever, and has a greater tendency to be prolonged, 
and occasion profound alterations either in the stomach or intes- 
tines, or in the viscera annexed to those of digestion, the liver, 
for example, the spleen, and mesenteric glands. 

The mucous intermittent fever, more common than the in- 
flammatory, is not less so than the gastric in low and damp coun- 
tries, especially in autumn. It is generally quotidian, or quar- 
tan, often erratic, sometimes tertian. " The paroxysms occur 
in the evening, and during the night; a horripilation constitutes 
the rigor; it is seldom accompanied with trembling; the coldness 
generally commences at the feet, and extends thence over the 
whole body; it is frequently accompanied by nausea, vomiting, 
cardialgia, abdominal tumefaction, alvine dejections and head- 
ache; the pulse is slow and concentrated. A moderate heat suc- 
ceeds; it establishes itself slowly, and with irregular returns of 
transient rigors. In the second period, the thirst is moderate, 
the pulse frequent, without being hard, the urine of a citron co- 
lour, somnolence sometimes irresistible. The third period is 
characterized by a slight degree of moisture: there is frequently 
an absence of all sweat in the first paroxysms. The duration of 
the paroxysm varies from three to ten hours, and upwards. The 
interval is generally marked by a sense of languor and weight. 
This fever is often indefinitely prolonged, frequently from one 
season to another.* 

It is impossible to add to this description which has been 
traced by the hand of a master; all the features of the disease 
demonstrate that this fever is owing to the shade of gastro-ente- 

* Nos. Phil. 1, p. 189. 



INTERMITTENT FEVER. 389' 

ritls, which constitutes continued mucous fever. The latter as- 
sumes the intermittent type more frequently than the gastric 
fever, while the mucous intermittent less frequently hecomcs 
continued than the gastric intermittent fever. Less grave than 
the latter, the mucous intermittent is more susceptible of passing 
to the chronic state and of producing profound alterations in the 
mesenteric glands, the spleen, and liver. 

4. The adynamic intermittent fever has been observed by 
Bayle; Pinel has seen some instances of it; he, however, thinks 
that facts of this kind are yet too limited in number, to permit 
us to describe with accuracy the distinctive character of this fe- 
ver. <c The apyrexia" he remarks, " is hardly ever complete; 
we observe this type of adynamic fever more particularly in 
subjects who have been debilitated by chronic affections, or by 
the lesion of some of the abdominal viscera. The paroxysms 
may be quotidian, double tertian, tertian, and quartan: they 
sometimes assume, alternately, these different types, while, at 
other times, they are irregular. The duration of adynamic in- 
termittent fever is still less known; it often succeeds continued 
adynamic fever, by which, however, it is more- frequently fol- 
lowed. It generally terminates fatally. 

We could hardly imagine that the inflammation of the diges- 
tive organs, which constitutes adynamic fever, could manifest 
itself by intermittent symptoms, if the simple exposition which 
has just been given, did not establish the fact. May not the 
momentary exacerbation of a gastro-intestinal irritation, provoke 
during some hours, adynamic symptoms, in individuals whose 
constitutions have been impaired, since we observe all these 
symptoms establishing themselves in such subjects in less than 
twelve hours? The irritation having ceased or diminished in a 
very marked manner, it is natural that the phenomena which 
characterize it should equally cease. Let it also be remarked, that 
the apyrexia is never complete; there is then only a diminution 
of tha gastro-enteritis, and this diminution is sufficient to dissi- 
pate the sympathetic symptoms, which announce the exacerba- 
tion, and constitute the paroxysm. Finally, the adynamy is 
never so complete and well characterized in adynamic intermit- 
tent, as in adynamic continued fever, except in the last parox- 
ysms, which approach each other and become confounded, when 
death is about to occur. 



390 PHYSIOLOGICAL PYRETOLOGY. 

Is there not room to think that the periodical exacerbations of 
different chronic phlegmasia may give rise to paroxysms, which 
have been considered those of an essential adynamic fever? 

"In ataxic intermittent fever."' says Pinel, •'•' we most fre- 
quently remark local anomalies, sometimes personating a phleg- 
masia, and sometimes having the character of a flux or neurosis: 
hence, the denomination of -pernicious fevers.' 3 

" It is not uncommon," adds this author, " to observe in these 
diseases, lesions of several functions at once. The paroxysms 
may be quotidian, double tertian, tertian, and quartan: they 
sometimes assume, alternately, several of these types, and are 
frequently irregular. They sometimes go on increasing in vio- 
lence, or are, alternately, violent, and the reverse. We are less 
acquainted with the duration of ataxic intermittent fever, than 
with that of continued: the danger is so great in the former, that 
we are obliged to suppress them as soon as possible, or, at least, 
to change their character. Abandoned to themselves, they are 
generally fatal, but they terminate happily immediately after the 
bark can be administered in an appropriate manner: they, how- 
ever, sometimes pass to the state of ordinary intermittent fever, 
or into that of continued ataxic fever. A relapse is frequent, 
and occurs in a septenary period from the paroxysm. There is 
cause for great apprehension in ataxic intermittent fever, espe- 
cially in the third or fourth paroxysm, if they have progres- 
sively increased, end are very intense, and if the bark has not 
been resorted to. The probability of recovery diminishes in 
proportion to the shortness of the intervals. The prognosis 
is also very alarming, when there is a tendency to a continued 
type. The symptoms which are of an ominous character in 
continued ataxic fever, are likewise so in ataxic intermittent."* 

This very succinct exposition can only give an imperfect idea 
of pernicious intermittent fevers, and, on this account, they shall 
be made the subject of the following chapter. 

Hildenbrand has mentioned an intermittent typhus, Deveze 
an intermirtent yellow fever: Pinel believes, notwithstanding 
the opinion of Bertrand, that it is not demonstrated that the 
plague has been intermittent: as there are no positive observa- 
tions illustrative of this point of doctrine, it appears to me un- 
necessary to dwell upon the subject 

-s. Phil. p. 250—291. 



INTERMITTENT FEVElt. 391 

M. Broussais refers all the essential fevers of authors to gas- 
troenteritis, simple or complicated: it results from this, that he 
considers all intermittent fevers as periodical gastro-enteritis, 
simple or complicated, but he acknowledges that the encephalon 
and the other viscera sympathetically irritated, may become the 
principal seats of irritation, and be inflamed in a periodical or 
continued manner. This second proposition renders the first a 
little less exclusive: nevertheless, it is contrary to all experience 
to attribute all these fevers to gastro-enteritis; for, 1st, Those 
which have commenced with inflammation of the stomach and 
intestines, are no longer gastro-enteritis, when the encephalon 
or other viscera become the principal seat of inflammation. 
2ndly, There are intermittents, without redness of the borders 
of the tongue, which, on the contrary, is white and moist, with- 
out thirst, and without pain of the epigastrium, even when pres- 
sure is made upon this region. Nothing authorizes us to attri- 
bute these fevers to gastro-enteritis, or we must consider all dis- 
eases as such in which there is reaction of the circulatory appa- 
ratus. Let the patients be examined attentively, and it will be 
found that the source of these fevers is in the encephalon, the 
lungs, uterus, and sometimes in the kidneys, or bladder. 

It shall, perhaps, be demonstrated at a future period, that many 
intermittent fevers are owing to a periodical irritation of other 
viscera than those which have been just mentioned, but hitherto 
there has been no proof that the liver, the pancreas, the spleen, 
and mesenteric glands can be primitively irritated in these dis- 
eases. All that has been said by Galen, Spigel, and Senac, with 
regard to the part performed by these organs in the production 
of intermittent fever in general, should be applied to gastro-en- 
teritis in the present state of the science, or, at least, to the secon- 
dary irritation, which they derive from the influence of this in- 
flammation; without, however, compromising ourselves, by de- 
claring beforehand against the ulterior results of observation. 
Certain facts induce me to believe that some intermittent fevers 
are owing to inflammation of the small intestine, or colon alone. 

The duration of the rigor, always longer in intermittent, than 
in continued fevers, and the cough which almost always accom- 
panies the paroxysms of the former, tend to prove that the vis- 
cera of the chest, and particularly the lungs, frequently suffer 
lesion in periodic fevers. Are the irritation of the lungs more 



392 PHYSIOLOGICAL PYRETOLOGY. 

frequently intermittent than that of other organs ? The present 
state of the science does not permit us to decide this point. In 
more than one hundred cases of intermittent fever, observed by 
M. Roche, he saw but a single case of intermittent pneumonia. 
But it is certain, that chronic intermittent fever, and especially of 
the erratic kind, is generally the result of a chronic phlegmasia 
of the bronchia, the lungs, or the pleura. 

It results from a comparison of the symptoms which charac- 
terize intermittent fever with those of continued fever, that the 
former are not more general than the latter, that they depend 
equally on irritation, and that their seat is the same. It remains 
to examine whether intermittent fevers are not occasioned by 
the irritation of certain organs, which are less frequently or less 
acutely affected in continued fever: this point will, perhaps, be 
at some future period elucidated by the progress of observation. 

Dissection cannot fcere furnish a proof of this doctrine, since 
death never occurs in the course of benign intermittents: we shall 
inquire, in the following chapters, whether this kind be entirely 
wanting. 

The causes of intermittent fever are the same as those of con- 
tinued fevers, but the former are more frequently than the latter 
produced by the action of marsh effluvia on the economy; of all 
the causes of intermittent fevers, these emanations are those 
which most frequently occasion it; nevertheless, Cullen has done 
wrong in not assigning other causes of these diseases. They may 
be occasioned by exposure in time of rain, by repeated excesses 
of the table, by prolonged and frequent watching, by a derange- 
ment of the uterine functions, the suppression of any periodical- 
discharge, the cessation of a cerebral disease; finally, by an irri- 
tation of the urinary organs, and particularly of the urethra. 

In the vicinity of marshes, intermittent fevers prevail during 
nearly the whole year, particularly in autumn and spring, and 
few persons escape. Those who have been only transient visit- 
ers in the infected neighbourhood contract the disease, or rather 
acquire such a predisposition to contract it, that the slightest 
cause may afterwards develope it in them, even after they have 
removed to a healthy situation. 

After having considered the relation which exists between 
the causes, nature, seat, and symptoms of continued fevers, it is 
unnecessary to perform the same task in relation to intermittent 



INTERMITTENT FEVER. 393 

fevers, since they present the same symptoms, scat, nature, and 
causes. 

But it is asserted hy certain authors — 1st, That the periodicity 
of a fever proves that it is not of the same nature as continued fe- 
vers; 2dly, That this periodicity indicates a scat different from 
that of continued fevers; 3dly, It is asked hy those authors, why 
marsh effluvia produce intermittent rather than continued fever? 

The periodicity of the morbid phenomena, designated by the 
name of fever, only proves that they depend upon a periodical 
organic affection, or one which is liable to exacerbations, charac- 
terized by these phenomena. 

This intermission of the symptoms only proves that the irri- 
tation which occasions them yields after a certain period, dimi- 
nishes, or ceases to provoke the sympathetic action of the organs 
in which they appear. 

The intermittence of fevers has excited the attention of ob- 
servers in every age, and they have endeavoured to account for it. 
Thus, they have been attributed by Thomas Willis to the peri- 
odical development in the blood of a fermentable matter; to the 
periodical introduction of the pancreatic juice, of too acid a cha- 
racter into the blood, by Fr. Deloboe; by Borelli to a successive 
irritation of the nervous extremities, of the nerves themselves, 
of the brain and motive fibres of the heart, occasioned by an 
acidity or acrimony developed in the nervous fluid. Torti has 
with reason asserted, that to these three hypotheses may be re- 
ferred all those which have been proposed to account for the 
production of intermittent fever. The third has prevailed. Boer- 
haave and Stoll attributed the intermittent fever to an inexpli- 
cable affection of the nerves; Selle made it depend, in part, upon 
a peculiar irritability of the nervous system, and particularly of 
the nerves of the primae viae; J. P. Frank approximates to this 
opinion. 

Reil has resorted to a very different mode of accounting for 
these diseases. Vitality is, according to him, liable to daily os- 
cillations, announced by the greater frequency of the pulse to- 
wards evening: these oscillations, which are scarcely perceptible 
in the healthy subject, become very evident in the course of 
diseases: and hence the exacerbations which occur from evening 
till midnight, and the remission which follows. Reil conjectures 
that the daily oscillations do not correspond to each other, but 

50 



394 PHYSIOLOGICAL PYRETOLOGY. 

that they affect a tertian type, which become particularly mani- 
fest in the sick. In this manner he accounts for the general ex- 
istence of this type in intermittent as well as in continued fever, 
and the usual termination of acute fevers on the odd days; con- 
sidering this law, however, as capable of being modified by a di- 
versity of circumstances. This author thought it absurd to assert 
that in the apyrexia of an intermittent fever the disease existed, 
although it did not manifest itself by any phenomena; for the 
same reason he rejected the distinction between periodical dis- 
eases and intermittent affections. He then attributes the inter- 
mittence of diseases to that of organic action in general, and es- 
pecially to that of nutrition. The intermittence of vital action 
appeared to him to have some relation to that observed in the 
universe, both having, according to him, the same cause; which 
he confessed himself incapable of unfolding.* 

These ingenious reasonings do not explain why certain causes 
occasion intermittent rather than continued diseases. M. Roche 
has endeavoured to solve this problem. He thinks that the causes 
which predispose to intermittent disease are always themselves 
of this character; that the causes which excite them are almost 
always intermittent; that sometimes the repeated action of these 
causes, sometimes the influence of habit, and often these two 
conditions united, cause the continuance of these diseases. He 
bases these propositions on the following considerations: 

Spring and autumn are, he observes, the seasons of the year 
in which intermittent irritations most ordinarily develop them- 
selves: those which are produced by marsh miasmata almost al- 
ways occur in the latter season. A character common to these 
two seasons being to present a considerable difference between 
the temperature of the day and that of the night, and often 
in the course of a few hours, three or four very sensible varia- 
tions in the temperature and humidity of the air, the result is a 
continual alternation of action and reaction in the human body, 
which at last contracts the habitude. Night puts an end to these 
impressions, but they are renewed daily, and in this manner 
there arises a predisposition to intermission. In this state, should 
a stimulus be applied to any organ whatever, it will the more 

* Analyse de la Pathologie generate de J. C. Reil, par M. Jourdan, dans le 
Journ. Univ. des Sc. Med. v, p. 44. 



INTERMITTENT FEVER. 395 

readily become the seat of an intermittent irritation, as its func- 
tions are already subject to a law of periodicity. Here the opi- 
nion of M. Roche approaches that of Reil. 

" The action of marsh emanations," adds M. Roche, u is pow- 
erless, or nearly so, during a part of the day; but every day it is 
felt in all its force at nearly the same hour. The putrid animal 
and vegetable emanations of marshes are principally disengaged 
when the atmospheric heat is greatest; the caloric then hastens 
their development, and augments the evaporation of water, which 
is their vehicle. These deleterious agents are carried up by the 
water, reduced to vapour, and mixed with the nearest stratum of 
air. This stratum of air soon becomes heated, and lighter than 
that which is above it, rises and gives place to a second, which 
in its turn becomes saturated, rises and is replaced by another: 
this process continues until the sun sinks behind the horizon. 
Then the earth gradually cools, the temperature of the air which 
is nearest to it is reduced, occasioning its condensation, and in 
consequence a precipitation of a certain quantity of miasmata; 
as the cold increases, the quantity of the miasms deposited be- 
comes greater. Condensed in this manner, and continually de- 
posited upon the skin, the pulmonary and digestive passages, 
they exercise a powerful action, which cannot be felt during the 
day, since they are then carried with rapidity to a height in the 
atmosphere." The action of marsh miasmata is then intermit- 
tent. 

These miasms, not being the sole cause of intermittent irrita- 
tion, M. Roche hence concludes that they do not possess the spe- 
cific property of giving rise to paroxysmal diseases. Shall it be 
said, that the repetition of paroxysms results from a peculiar 
modification of the tissue, the lesion of which occasions the sym- 
pathetic disturbance? He very properly considers this proposi- 
tion destitute of force, since every vital phenomenon depends on 
a particular organic modification. He considers the repetition 
of the paroxysms as a consequence of that tendency of our tis- 
sues to repeat certain acts, only because those acts have already 
been executed several times. But the paroxysms arc sometimes 
independent, and are only repeated because the causes are re- 
newed: this is the case in those who are cured by their removal 
from the marshy districts, and when the paroxysms are sepa- 
rated by an interval of ten, fifteen, twenty or thirty days, and 



396 PHYSIOLOGICAL PYRETOLOGY. 

more. " Finally," says M. Roche, "the paroxysms are some- 
times kept up both by habit and the continued action of the mi- 
asms: this is the case with those who continue to reside in the 
infected situations." 

In this manner M. Roche thinks we can account for the inter- 
mittence of irritations. Intermittenee of predisposing causes, in- 
termittence of occasional causes, habit, intermittenee of morbid 
effects. Such is, according to this author, the natural concate- 
nation of facts, and the most natural explication which can be 
given. 

If it be objected that intermittents sometimes develop them- 
selves in towns, during the most uniform temperature, under the 
influence of some cause which has suddenly presented itself, such 
as terror, aversion; and that then, at least, the intermittenee of 
the disease cannot be attributed to the intermittenee of its cause, 
he answers that the disease has been produced, or at least pre- 
pared by periodical causes, the periodicity of which has not been 
observed. "Let the patients be interrogated," says he, "and 
it will be discovered that one has every day endeavoured to re- 
store his impaired appetite by highly seasoned food; another has 
been excessive in the use of ardent spirits; another in the use of 
coffee: in fact, that they all have transgressed the laws of Hy- 
geia, at hours which have been nearly fixed. 

The intermittenee of periodical neuralgia, determined by in- 
stantaneous causes, such as a fall, or the drawing of a tooth, ap- 
peared to him to be referrible to the existence, in some subjects, 
of so great a tendency to the repetition of sensations once expe- 
rienced, that when a single impression of any power is made on 
the organism, the sensation which accompanies it is renewed on 
the next, and on the following days. 

As to the diversity of types, he thinks that the cause of it 
must be sought in the difference of the excitability of the sub- 
jects, although he confesses that this point requires elucidation.* 

The idea of attributing the intermittenee of maladies to inter- 
mittenee of the causes which produce them, and to a tendency 
of the organs to repeat movements which they have performed 
once, and especially several times, appears to me to be very hap- 

* Voy. la Refutation des Objections faites a la nouvelle doctrine, par M. 
Roche, p. 159; et son Analyse de l'ouvrage de M. Mongellaz, dans les Ai> 
nales de la Medicine Physiologique, vol. i. p. 116—127. 



INTERMITTENT FEVER. 397 

py. But the union of these two conditions is, I think, necessa- 
ry to determine an intermittent disease; otherwise it will be 
asked, why, since intermittent morbific causes are the most fre- 
quent, intermittent diseases are the most rare. By admitting an 
organic predisposition, we explain why, in a marshy country, 
all the inhabitants, and all those who pass through it, do not 
contract the intermittent fever, even supposing the circumstances 
are the same in every case: we likewise, in this manner, account 
for the fact of marsh miasmata determining continued fevers in 
some. 

Since marsh exhalations occasion, though more rarely, conti- 
nued fevers; since intermittent fevers, even those which owe 
their origin to marsh exhalations, are frequently converted into 
continued fever; although marsh exhalations are the most com- 
mon cause of intermittent fevers, we cannot hence conclude that 
the latter is of a different nature from the former. 

When we compare two species, paying no regard to another 
which separates them in the natural order, we imagine that we 
observe between them a very marked disparity; but let the se- 
ries be re-established, and this disparity in a great measure dis- 
appears. 

It is in this manner that there appears to be a very marked 
difference between continued and intermittent fevers; but if we 
consider remittent and sub-intrant fevers as occupying the in- 
terval between them; if we reflect upon the frequent transfor- 
mation of these fevers into each other, we can no longer assert 
that the difference of type is a certain index of a specific diffe- 
rence in the diseases. Here, perhaps, more than upon any other 
occasion, we should remember that our classifications are most 
frequently founded upon external appearances, which are only 
important as they affect our senses, and which in their nature are 
entirely secondary. 

Many physicians are still of opinion, that fevers are intermit- 
tent, only because they have their seat in the nervous system. 
This opinion explains nothing; for it remains to inquire, why 
and how nervous fevers are intermittent, — in what intermittent 
nervous fevers differ from continued nervous fevers. Pinel has 
proved that intermittent fevers, which are said to be devoid of 
inflammatory, gastric, or mucous symptoms, appear to be so, 
only because they are still in their incipient stage, or are de- 



398 PHYSIOLOGICAL PYRETOLOGY. 

clining, and consequently of little intensity. I shall only add, 
that there is no intermittent fever without symptoms of irritation 
predominating in some part of the body, and that were there only 
the irritation of the heart, it should not be overlooked, and the 
seat of the disease vaguely referred to the nervous system. 

And, after all, what are we to understand by this pathology? 
Is it meant that there is lesion of the whole nervous system in 
intermittent fever? This would evidently be an erroneous idea; 
for what alteration is usually observed in the organs of sense? 
"When we reflect upon the analogy of the effects on the orga- 
nism of fear and cold to febrile phenomena, we are inclined to 
consider the brain as performing an important part in intermit- 
tent fever; at least this opinion is not devoid of all probability. 
But, if this organ is slightly irritated in many periodical, as well 
as in many continued fevers, this lesion is generally of so little 
intensity, that it would be blindness to attribute to it all the 
symptoms of the first; or, to be consistent, it would be necessa- 
ry to refer to it the production of those which characterize the 
latter. The brain suffers lesion only in some cases of inflamma- 
tory intermittent fever; it suffers in a less degree in some inter- 
mittent pernicious fevers: the highest degree of cerebral lesion 
occurs in pernicious fevers, which shall be treated of hereafter. 

M. Guerin thinks that the cerebro-spinal nervous centres in- 
eontestably perform a part, even the principal part, as well in 
the production of the phenomena of intermittent fever as of 
those of fever in general, but that these fevers do not really ex- 
ist with all the conditions which characterize them, with all their 
attributes; except, when by a direct action of the causes, or in 
consequence of sympathetic influences, or otherwise, the dis- 
turbance of the functions extends to the circulatory apparatus. 
The circulatory system then performs a necessary part in the 
production of the paroxysms of intermittent fever: now, this 
part manifestly consists only in the determination of blood to 
the diseased organs and its accumulation there. It cannot, then, 
be asserted, in an absolute manner, that the intermittent fever 
has its seat in the nervous system. Considering the fever in it- 
self, or in its characteristic accidents, all of which are referrible 
to an excitement of the circulatory system; as frequency of 
pulse, heat, &c, we find that its positive seat, considered ab- 
stractedly from its type, is in the vascular system. But, consi- 



INTERMITTENT FEVER. 399 

dering intermittent fevers in respect of their intermittence, and 
the congestive phenomena of the paroxysms, we also find that 
their first cause is very decidedly in the nervous system, and 
that, in this point of view, we may regard these fevers as having 
their seat there. Farthcrmore, M. Gucrin, divides intermittent 
fevers into those which depend upon a direct and primitive le- 
sion, on a proper abnormal excitation of the cerebro-spinal cen- 
tres, and those derived from a lesion, purely sympathetic, of the 
same parts, their abnormal excitation arising from irritation ex- 
isting in other parts of the economy. The first immediately 
manifest the character of intermittence which is proper to them: 
the others, at first continued, only assume the same character at 
a later period. The local affection, in symptomatic intermittent 
fever, is generally the principal morbid element; while, in idio- 
pathic intermittent fever, the principal morbid element is the fe- 
ver itself, or rather the lesion of the nervous centres which ex- 
cites it, and the general reaction of the sanguine system which 
characterizes and constitutes it to the eyes of the observer. 

It then appears that M. Guerin beholds in intermittent fevers 
only ' abnormal excitations of the cerebro-spinal centres, pro- 
voking or complicating an afflux of the blood to other organs, 
and its accumulation in them, congestions and irritations in other 
points of the economy. He farthermore asserts, that, in indi- 
viduals who die of intermittent fever, the cerebro-spinal centres 
are usually found in a state of congestion; their substance is red, 
softened, injected, infiltrated; the vessels are distended, gorged 
with blood, and their connexions often inflamed. 

Thus M. Guerin gives the name of idiopathic intermittent fe- 
vers to primitive nervous sur-ex citations characterized by perio- 
dical symptoms; and that of symptomatic nervous fevers to ner- 
vous sur-excitations characterized by periodical symptoms, but 
derived from internal or external organic irritations. 

Intermittent fevers are then, in his opinion, diseases more par- 
ticularly nervous; and, since he regards the nervous system as 
performing the first part in fevers in general, we have all fevers 
ranked among diseases of the nervous system: if this be admit- 
ted, we must, likewise, assign the same place to a great number of 
phlegmasia^, which commence absolutely in the same manner as 
fevers. It remains to be determined, why intermittent fevers 
are intermittent: the reason assigned is, that in them the afiec- 



400 PHYSIOLOGICAL PYRETOLOGY. 

tion predominates in the cerebro-spinal centres, while in conti- 
nued fevers it occupies the whole circulatory system and gan- 
glionic nervous apparatus, the cerebro-spinal system participating 
only accidentally in a manner which is remote and unnecessary. 
On the other hand, the vascular and ganglionic system are only 
affected secondarily in intermittent fevers. We shall glance at 
the manner in which M. Guerih applies these principles, when 
on the subject of remittent fevers. 

Doubtless, it may be asserted, that the nervous system per- 
forms an important part in the production of fever in general, 
and in that of intermittent fever in particular: it may be assert- 
ed, that in the latter the nervous system performs the first part, 
and the opinion may be supported by ingenious comparisons 
with the phenomena of neuralgia and other affections more ma- 
nifestly nervous. But the part which the ganglionic system per- 
forms in a state of health is too imperfectly understood to per- 
mit any positive assertions with regard to its influence in a state 
of disease. Medical sophistry, which formerly found employ- 
ment in the humours, at the present day takes refuge in the ner- 
vous system. Let us regard the theories of M. Guerin and 
others as ingenious views, which require the sanction of time, 
and let us not hastily make them the basis of our therapeutic me- 
thods: where experience speaks clearly, theory, if it has nothing 
positive to offer, should be silent. 

M. Guerin declines to give the name of inflammation to in- 
termittent fevers: let him then decidedly trace such a line of de- 
marcation between inflammation and sur-excitation, congestion 
and irritation, as shall be adopted by the whole medical world. 
Until this is done, sur-excitation, irritation, and phlegmasia shall 
continue to be morbid states, slight and transient, or profound 
and durable, or even irremediable, according to their degree and 
energy, the duration of their causes, the disposition of the sub- 
jects, the mode of treatment, &c. To endeavour to decide whe- 
ther a disease has arrived at the degree of inflammation, can be 
of no utility, except where inflammation would require some 
specific remedy, which might be dangerous in the case of irrita- 
tion, excitation, or congestion. But this is not tbe case, the 
same means are applied in different degrees. The only diffe- 
rence consists in more or less activity, the employment of deri- 
vatives, and blood-letting, which varies with the symptoms, 



INTERMITTENT FEVER. 401 

the intensity of the disease, and the type, when it is intermit- 
tent. 

It is with pleasure that we see the nervous system becoming 
the object of special researches; but, unfortunately, the subject 
of these researches are facts already known, and not new disco- 
veries and new experiments. I know not why the various re- 
searches, with regard to an apparatus which connects all the or- 
gans, should not be united, and carried with utility into thera- 
peutics. 

The distinction established by M. Guerin between intermit- 
tent fevers, in which the cerebro-spinal system is primitively af- 
fected, and those in which it is only secondarily affected, would 
be of great utility were it only founded upon nature, notwith- 
standing the improper denominations he applies to them; but 
the means of making this distinction at the bed-side of the pa- 
tient, presents a difficulty, even admitting that it is founded upon 
nature, which we must be allowed to doubt, as we have not been 
able to make it in practice. Many, before this author, were de- 
sirous of distinguishing intermittent fever into nervous, inflam- 
matory, &c; but none had given as primitive those which com- 
mence with "the intermittent type, and as symptomatic, those 
which commence with the continued type. According to this 
view, every intermittent fever, properly so called, would be idi- 
opathic, and the local affection connected with the reaction would 
be secondary. It was not worth while to take so much pains to 
return to the point of departure. 

M. Alard places the seat of intermittent fever in the absorb- 
ent vessels, and he thinks that in this manner the type of these 
fevers can be accounted for; but for this it would be necessary 
that all intermittent fevers had their seat in the absorbent system. 
This objection is of equal force against the theory of authors who 
pretend to explain the intermittence of fevers by making them 
depend upon the nervous system. 

Let the few physicians who at the present day pretend that 
there is something specific in intermittent fever, and who hence 
conclude that they are essential, state in what this specific some- 
thing consists; let them declare its cause and nature, and the in- 
dications derived from it. Until then we shall continue to be- 
hold in intermittents only irritations of one or more organs, 

51 



402 PHYSIOLOGICAL PYRETOLOGY. 

giving rise to intermittent phenomena. It is time that the 
known should take precedence of the unknown. 

The fact of their intermittent character has been considered 
as proving that they could not be owing to an inflammation. 
But it has not been asserted that they were owing to an inflam- 
mation equally intense with that of the cellular tissue, and it is 
sufficient to admit that they depend on some one of the shades, 
sometimes slight, and sometimes intense, of this morbid state. 
I shall not stop here to prove, in opposition to the opinion of M. 
Tommasini, that inflammation, the best characterized, may ap- 
pear under the intermittent type. I appeal to experience and 
the knowledge of educated physicians, and, consequently, to M. 
Tommasini himself. M. Tommasini thinks he has never, or at 
least very seldom, witnessed intermittent phlegmasia^: this arises 
from his haying considered those which presented themselves in 
the course of his practice as essential fevers. 

If I have demonstrated that intermittent and continued fevers 
differ only in their type, and that a difference of type does not 
indicate a specific difference in the nature of the organic altera- 
tion, it has been proyed that both these classes of fever depend 
upon a local irritation, the extent and depth of which it is desi- 
rable to study with more care than has hitherto been done. 



Treatment of Intermittent Fevers, and especially of Benign 
Intermittent Fever. 

The first question under the head of the treatment of these 
fevers, is whether it is proper to attempt their cure. However 
absurd this question may appear, it has become necessary since 
Boerhaave was pleased to say that intermittent fever disposed to 
longevity. The fact that in a very limited number of cases, me- 
lancholy, mania, gout, epilepsy, and palsy were observed to 
cease after its appearance, has given rise to the belief that this 
fever might sometimes be beneficial in its effects. 

If it be true that the intermittent fever is so beneficial to ma- 
niacs, epileptics, the gouty, and paralytic, I know not why they 
should not be sent to the Pontine Marshes or to Batavia, instead 
of prescribing the pure air of the P3T*enees or of the Gold Coast. 
Let those, at least, who are free from these diseases get rid of 






INTERMITTENT FEVER. 403 

the intermittent fever as soon as possible; and let it suffice to re- 
spect it in maniacs, epileptics, and paralytics, and even the gouty, 
if they prefer the fever to the gout. 

It is certain that in proportion to the repetition of the parox- 
ysms of intermittent fever, when they do not progressively di- 
minish in intensity, the subject becomes more or less rapidly de- 
bilitated, the digestive organs become irritated, when they have 
not been so before, and at last retain their irritation during the 
apyrexia. The viscera, which co-operate in digestion, the liver, 
spleen, and mesenteric glands become gradually affected: we 
hope that this repetition will not be termed superfluous. 

It may then be concluded, that it is important to arrest the par- 
oxysms of an intermittent whenever ft can be effected without 
occasioning evils of a more serious nature, or at least equally se- 
rious with those which are to be remedied. This distinction, 
it is true, is not always readily made. * It is believed, that in 
many cases the remedial measures employed in intermittent fe- 
ver appear to perpetuate it, and occasionally when they suppress 
it, that they favour the morbid development of the spleen, the 
liver, or mesenteric glands: the facts which establish this propo- 
sition are too numerous to allow any doubts on the subject. They 
have been the source of discussions which have never been 
brought to a satisfactory conclusion. 

It appears to me that the consequences, frequently unfortunate, 

! of the treatment generally employed, hitherto have arisen, 1st, 

' from the nature of the treatment; 2d, from the morbid predis- 
position of the gastro-intestinal mucous membrane of the liver, 

j spleen, mesenteric glands or thoracic viscera; 3d, from the con- 

! tinuance of the morbific causes. 

The first thing to be done for the cure of intermittent fever, 
more especially than for that of any other fever, is to investigate 
with care all the circumstances to which the patient is subjected. 
If, for example, the disease is the effect of marsh-miasmata, in 
vain shall we resort to the most powerful therapeutic means: 
either they will fail, or they must be employed with an activity the 
consequence of which must be injurious even when we procure 
the cessation of the fever, that is to say, of the intermittent sym- 
pathetic symptoms of a lesion which we shall render continued 
by the employment of drugs. A change of residence, food, 
employment, and journeys, cure more intermittent fevers than 



404 PHYSIOLOGICAL PYRETOLOGY. 

medicine. The same remark applies to lively emotions, and 
passions which give a centrifugal direction to vital action. When 
these measures are not sufficient, they contribute greatly to the 
efficacy of other therapeutic agents. 

The morbid predisposition of the abdominal and pectoral vis- 
cera should be attentively considered in the treatment of inter- 
mittent fevers, with a view to the choice of decisive means or 
of preparatory measures, which may ensure the success of these 
means or prevent their occasioning any disagreeable accident. 
Whenever a subject predisposed to chronic irritations of the vis- 
cera, if either of these cavities be affected with intermittent fe- 
ver after having removed the external causes which may have 
occasioned the disease, or which may keep it up, we must has- 
ten its cure when it depends upon irritation of the digestive or- 
gans; for this irritation, by its repetition, ultimately gives rise to 
chronic irritation of the neighbouring organs. Nevertheless, 
it is then useful to resort to the means which diminish the mor- 
bid predisposition of the latter. The same course is to be pur- 
sued when an affection of the chest is to be apprehended: this, 
however, does not occur, except under the influence of external 
causes which cannot be removed, or when there has previously 
been an inflammation of the pleura, bronchia, or pulmonary pa- 
renchyma, capable of being exasperated under the sympathetic 
influence of a gastric irritation.* With regard to subjects pre- 
disposed to encephalic irritations, mental diseases, their maladies 
are so dreadful, that, as we have already remarked, it is much 
better not to oppose the progress of the intermittent fever than 
to attempt its cure, although it may not be impossible ultimate- 
ly to remedy the latter without recalling the former. 

The treatment of intermittent fever having been hitherto pure- 
ly empirical, we can be but little surprised, that employed as it 
frequently is, with too much energy without preparation, and 
even at an improper time, it has often been injurious even when 
it has arrested the fever. 

The ancients, who were not acquainted with the Peruvian 
bark, treated intermittent in the same manner as continued fe- 
vers: a series of bleedings and evacuants constituted the treat- 
ment. During the first days, severe abstinence was prescribed; 
friction was forcibly used over the surface; baths were employed, 

* Histoire des Phlegmasies Chroniques. 



INTERMITTENT FEVER. 405 

and wine was then given in doses, progressively increased: at 
the instant the paroxysm was about to appear, they heated the 
surface by all possible means. In the case of a young lady, I 
succeeded in preventing a paroxysm by covering the body with 
very hot cloths, constantly renewed at the moment when she be- 
gan to feel the rigor. This measure, which is too much ne- 
glected, hot baths and frictions would obviate the necessity of 
resorting to the employment of many of the other remedies if 
they were resorted to with energy on the approach of the pa- 
roxysms. Stoll ranks sudorifics, anodynes, the bath, confine- 
ment to the bed, exercise, sinapisms, and blisters among the 
means which may prevent the return of the paroxysm when they 
are employed a short time before its expected invasion. 

When the employment of chymical compounds was introduced 
into the practice of medicine, they supplanted the wine used by 
the ancients, and in their turn yielded to bark. 

When the bark was first introduced into Europe it found warm 
partisans, and antagonists not less ardent: the most remarkable 
among the first was Forti, and among the latter was Ramazzini. 
Both exercising the medical profession in the same country; one 
endeavoured to exalt the virtues, the other the dangers of this 
medicine. Ramazzini had at first highly extolled this medicine, 
and it was only after a long experience that he recognised its in- 
jurious effects; he did not entirely proscribe it, but only limited 
the cases in which it was an appropriate remedy. Forti recom- 
mended it in all cases without exception, and his opinion has 
predominated to the present day. Since his time, the use of 
bark has extended not only from pernicious fevers to benign, but 
likewise to continued fevers. If it be beyond dispute that this 
medicine renders invaluable services in intermittent fevers, (and 
its services are here as evident as its victims in continued fevers 
have been numerous;) it is not less true that the blindest empi- 
ricism alone can prescribe it in all intermittent fevers. 

On account of the high price of the cinchona, its scarcity un- 
der some circumstances, and the great disgust it occasions some 
patients, an attempt has been made to discover therapeutic agents 
which might be substituted for it. Such agents have been dis- 
covered, but none of them has been employed so frequently as 
this article in intermittent fevers; so that it is still considered as 
the remedy upon which we must principally depend: it is greatly 



406 PHYSIOLOGICAL PYRETOLOGY. 

preferred in most cases, although other means have succeeded 
equally well: less frequently, to be sure, because they have been 
less frequently employed. 

These preliminaries being indispensable to avoid repetitions, 
let us now inquire what have been the principal methods em- 
ployed to the present day in the treatment of intermittent fe- 
vers, and especially in that of benign intermittents. 

Frank traces in the following manner the treatment of benign 
intermittent fever with complication, that is to say, that which 
is neither gastric, inflammatory, pernicious nor masked. After 
two or three paroxysms have revealed the nature of the disease, 
and when its appearance has not been coincident with the cure 
of another disease, he prescribes cinchona in substance or alone. 
"Sometimes/' he adds, "on account of the idiosyncrasy of the pa- 
tient, the sensibility and irritability of the stomach and intestines, 
the bark irritates the stomach and occasions oppression, it is re- 
jected by vomiting, or passes off rapidly by stool." In the first 
case, he recommends an agreeable aromatic, and in the second, 
opium either before the febrifuge or together with it. Although 
the cold and hot infusion of bark, the decoction, the gummy or 
resinous extracts, and even lavements, and the external applica- 
tion of this substance have often cured the intermittent fever, 
the bark in substance is preferable. It should be administered 
in the apyrexia at least an hour after the termination of the last 
paroxysm, and two hours before the commencement of the suc- 
ceeding one. If it be administered within the two hours pre- 
ceding the paroxysm, the patients are often affected with a high 
degree of sensibility; they experience nausea, the greatest re- 
pugnance to the medicine, and reject it. Two drams are gene- 
rally sufficient — but it is sometimes necessary to give three, four, 
and even six, either in a single dose or directed according to the 
length of the apyrexia — with an interval of half an hour between 
the doses, which are to be apportioned in such a manner that the 
smallest be given last. 

The first paroxysm which succeeds the administration of the 
bark, frequently presents no diminution; it is frequently even 
more violent than the preceding: a circumstance which should 
not prevent a perseverance in the employment of the medicine. 
It is generally necessary to administer three ounces in the whole 
course of the treatment. The doses should be the more consi- 



INTERMITTENT FEYEK. 407 

derable in proportion as the parox)-sms are less marked, until 
they have altogether ceased: afterwards the medicine is still to 
be continued, but in more feeble doses, at greater intervals. 

Frank asserts that the bark alone does not always succeed, 
that it fails in some individuals, and that the. fever yields more 
readily to this medicine in combination with opium, or to opium 
alone, ipecacuanha or tartar emetic given in small doses, to the 
use of some article of food which is longed for, no matter how 
singular the choice may be, to a change of airj and, finally, to 
amulets. 

The resistance of the fever to the action of bark, often de- 
pends, according to this author, on the fact that it is not legiti- 
mate: by this he means that there exists an unknown compli- 
cation, such as internal collections of latent saburrm, a tendency to 
plethora, or an obstruction, a scirrhus of some of the viscera, espe- 
cially of the liver or spleen, a specific vice, the suppression of a flux, 
which, he adds, require a specific treatment, sometimes admitting 
of none, and becoming exasperated by the inconsiderate use of 
the bark. 

These principles were a few years since those of the most 
skilful practitioners; they are still, if we reject the obsolete the- 
ory in the terms of which they are stated, the positive result of 
facts. As it has already been remarked the observations of sim- 
ple intermittent fevers are all incomplete, either because the au- 
thor who reports them has omitted the signs of irritation of the 
stomach, of the chest and encephalon, or because he has not re- 
cognised them, or finally, because he has touched but slightly 
upon them, because he was not aw r are of their importance. 
There is not perhaps a single case of intermittent fever, which 
admits of the employment of bark alone. Had Frank and the 
physicians who entertain his opinions, been acquainted with the 
signs of gastric irritation, they would have known that the con- 
tinuance of this irritation explains the cases in which bark does 
not cure intermittent fever much more satisfactorily than the 
idiosyncrasy of the patient, saburm, obstructions, specific vices, the 
suppression of a flux. It cannot be said that these physicians re- 
cognised the existence of gastro-enteritis, because they speak of 
the sensibility and irritability of the stomach and intestines: this 
sensibility and irritability was only in their view an individual 
peculiarity, and not the proximate cause of the febrile phenome- 



-1 ; 5- v FHTSIOLOGICAL PYMTOLOGY. 

na. As to plethora, fhey are deserting of credit for baring 
recognised the obstruction it presented to the cure by bark. It 
is well known at the present day, tbat tbis condition of tfc z 
tern disposes the bear! to irritation, is singularly favourable to 

zzzz ;;-;.:.:::.:: : :' z: ; ".: :-i.:. " :■:.: 5. ::::::;:: :ii ^::::i:: z::t 
i zr.zz :.:'.z :: '.zzzzzzz i:.: i ::. .":-; :7r .:>: : :' :l:7 ~:t: iz.r 
:Y::7i .::.::::i r-r.5 lit? :~ i :.:':;i:: - :.z: : :' zzz sjf.rzi. 

Iif.c-ii ::"::■".*: " .: _ 7. : : .'.: : .z Ji.= :i::f.".::: : :' v.e :::.i:~::! 
: :" ; ; ;_ "7. . : ' . :- : . : - : zz . : : -. z : :z - z- : . — z « ; .:'.'. :i zzz '.zz ;:.: r_ r zz .: r-= ? 
recommended by S toll and Cnllen during the paroxysm of in- 
zzzzzzzz: \-zZ.z zzzzzz'.. : :' ..7.: .i:.;_- .:::;;- _z:zz zz..z.zzz :z z z- 
ticujar. We shall then give the opinion of Pinel with regard to 
zzz zzzr.zzzzz.z :::::::.:^-:: ; ::.: :zzz7zzzzzzzz5. 

■I _:.-;•.: .7 ::".: : :: ; :; 5 V..77. ••~:z: ; ::.:::;::f^::z:7 
and warm diaphoretic drink: it must be frequently given and in 
small quantities: by tbis means, aided by the warmth of the bed 
zz.' :t 7:f zzzzz 7 ; f : ~ :- :. : :r= ': z: : . = zzz izzzz'z. ~z zzz~ :rz- 
Tent a troublesome vomiting during the attack." 

In ilf 7;: =-..;. z^, - :-_ :. : i. . .j '..: :-: :z~z:.zz :zi '.zzz: zzzz zzz 
fzzzzz'.z: :.z- 7 :7 = :=Tr: .5 :::::i.-;. zzz 57: z:: z'.zzziz.z zzz 
Lszzs<zdzz zzzz.zzz-. :7 : z-lzzz-zz s'z.zii 'zz :i_:_: :7t z ri> 

-_.5.r-7 

7..T — ioiizz rzr: ::~.:: ::zi:::7, i: s7:7i ";«= z^-7t 
kr~: "i- '-j :::i:^::: :: ':•=£. :;• ~::::. ::7i7i. zzz zzzzzzliz 
of elder blossoms, wine wheyj it must not be provoked by pow- 
er::! zzzr.zs. Azzzz zzz s~ z-iiizz 5::zr.. ::;:ir. 7.^: ::.:;:::- 
r-.f7— ri: zt "::■::• 

If it be added that the application of leeches to the epigastrium 
or temples, is often preferable to venesection, tbat the whey 
57: 7i _r rx7._:c7. : :. i zzz. z: zz'Szzzz zz szzzli z:z 'zz 'zzszzly 
Z~zZ. ZZZzz zzzzzz. zzzizz.z zzz 5.7 zz.z zzlj zzz ~z:zzz 
i'zzzii zzzzlzzz ; .: ::::;:: izri.r.z zzz zzzizj^zz :z zzzzzzz- 
zzzzz zz~zz~. 

Sz:c r'.zz'. zzs zzz izzz'z zzzzzzzzzzzzzj izzzzzzzzzzz'j, ~e 
zzziz ::::f7: S:.77 7; zzz ;::;rr zzz-iz ::" zzzzzizz z'zzsz i s- 
t.ii.i.5- •• Tzz izzziz'zl:z'.5zzz zzzzz::." 5z~s S:77. "if ;::;^: 
zzz zz :~ 'zizz .z.zr.z? :: ;:;.:; :z z.:zz :: :7".z.:ri: 21 i i7ile7: 
:i:.*""7:75. izl: ~'zzz zxzza :: zzzlzz [5 z'zzz :zzzz :z zzz zz~zr. 
in those of individuals disposed to inflammations and apoplexy, 
are in a sKgit state of peripneumony or of pleurisy, or 



INTERMITTENT FEVER. 409 

in those who spit blood; in a fever which, owing to the nature of 
the epidemic, very easily degenerates into continued inflamma- 
tory fever, when the paroxysms arc prolonged and the apyrexy 
is not complete, when there is violent and inflammatory headache, 
and furious delirium." 

This able practitioner, then, recognised the necessity of cm- 
ploying the antiphlogistic method against intermittent gastro- 
enteritis; pleurisy, peripneumony and encephalitis, or the inter- 
mittent sympathies of spring, which he had the penetration to 
discover through all the darkness in which the theories of his 
time involved the subject. But as it is the privilege of no one to 
throw off entirely the prejudices of the age in which he lived, 
he permitted the exhibition of the neutral salts; eccoprotics, in 
conjunction with venesection. These medicines, even when ad- 
ministered with the greatest reserve, could not be altogether free 
from inconvenience, except when the irritation was seated in the 
encephalon: they certainly kept it up when it resided in the sto- 
mach and intestines. 

Cullen established three general indications in intermittent fe- 
ver: 1st, during the intermission to prevent the return of the pa- 
roxysm; 2d. during the paroxysm, to employ such measures as 
may procure a perfect crisis of the disease; 3d. to obviate cer- 
tain circumstances which might prevent the fulfilment of the 
two first indications. 

The first indication was answered, 1st, by stimulants given 
internally without exciting sweat, or given in such a manner as 
to excite sweat and keep it up for some time after the period of 
the paroxysm has passed by, doses of tartar emetic only capable 
of exciting nausea, and administered an hour before the time of 
accession; 2d. by astringents alone, bitters alone, astringents and 
bitters united, astringents and aromatics united, the metallic to- 
nics, the narcotics or a lively impression of fear. At the same 
time he recommended exercise and as much food as the appetite 
and digestion permitted. 

The cinchona may be given without danger, at all periods of 
intermittent fever, provided the inflammatory diathesis does not pre- 
dominate in the system, and there be no considerable or fixed conges- 
tion in the abdominal viscera: the proper time for its exhibition, 
is the intermission: it should not be administered during the 
paroxysm: it must be given as near to the access as the state of 

52 



410 PHYSIOLOGICAL PYRETOLOGY. 

the stomach will permit; it is not sufficient to prevent once by 
its employment the return of the paroxysm; the use of it must 
be continued at proper intervals. 

To fulfil the second indication, he gave, 1st, Emetics during 
the cold stage, or at the commencement of the hot stage; 2nd, 
Narcotics during the hot stage. 

When the inflammatory diathesis prevailed in the system, and 
there were fixed congestions in the viscera of the abdomen, he 
dissipated the first by blood-letting, and the antiphlogistic regi- 
men; and the second, by emetics and purgatives. This method 
was, certainly, not always successful; for he adds, " When these 
means do not succeed in a short time, I think it is a more cer- 
tain method to attempt the cure by stimulants which are non- 
sudorific, by tartar emetic in nauseating doses, than by astrin- 
gents, bitters, aromatics, tonics, and narcotics, &c* 

It thus appears, that Cullen was well aware of the frequency 
of inflammation, at least in intermittent fever, and of the impro- 
priety of administering tonics under these circumstances, and 
that he then attempted the cure of the fever by a revulsive, or 
anti-gastric mode of treatment: but he was ignorant of the true 
nature of the pretended embarrassments, the congestions of the 
digestive passages, and he employed nauseating doses of tartar 
emetic, where, at the present day, leeches are applied with suc- 
cess to the epigastrium, the hypochondrium, and anus, It was, 
however, far from being the fact, that the treatment of these fe- 
vers reduced itself to the empirical administration of cinchona. 

Sydenham, Pringle, Huxham, Grant, and many other practi- 
tioners, had recommended blood-letting in the vernal intermit- 
tents.' It was reserved for our age to witness the proscription 
of so powerful a means of treatment, in this disease. But it 
must be remarked, to the credit of our medical brethren, that, 
notwithstanding the anathemas which have been directed against 
this operation, they continue to employ it with advantage. 

I have seen M. Broussais, in vernal intermittents, prescribe 
venesection, or the application of leeches to the epigastrium, ac- 
cording as there appeared to be excessive sur-activity of the 
heart, or only gastritis, and afterwards, administer the quinine 
from the first accession of the disease: this method succeeded 

* Med. Prat. Paris, 1785, 1, p. 175. 






INTERMITTENT FEVER. 411 

perfectly, and I have since derived the same advantage from its 
employment. 

Blood-letting, and the application of leeches in many cases, 
suffice for the cure of intermittents. 

On the 12th of July, 1825, M. Piollet was called to see M. 
N***, who, in ascending the Rhone in a boat, fell into a deep 
and rapid place in that river; through fear, and the impression of 
the water, he became senseless; when consciousness was re- 
stored, he was seized with a chill which lasted an hour, and was 
succeeded by a fever which lasted six hours; the paroxysm ter- 
minated with an abundant sweat: during the hot stage, he had 
vomited several times with very acute pains at the epigastrium, 
which decreased during the sweating stage. He passed the fol- 
lowing day in this state of continual malaise, with frequent nau- 
sea, and a constant pain at the epigastrium. The next day he 
was seized with a paroxysm in all respects similar to the first, 
with vomiting and extreme anxiety. The patient stated, that in 
the month of May, he had a tertian fever, for which he had 
used different remedies, and among others, bark, which had ar- 
rested the disease, leaving, however, a slight pain in the sto- 
mach. This pain was more sensibly felt on the days correspond- 
ing with the paroxysms. He experienced a relapse on the 18th 
of June, owing to exposure to rain. The disease being rigo- 
rously combated by tartar emetic and bark, administered at im- 
proper periods, disappeared after the fourth paroxysm, leaving 
after it a very acute pain of the stomach, which increased when 
he drank wine or liquors. The sense of heat, dryness, and im- 
paired health was more considerable on the day of the paroxysm 
since the relapse. The patient was in this condition when the 
accident occurred. I was called in on the third day after the 
accident. On the moment of the accession, and during the hot 
stage, I endeavoured to allay the vomiting with cold lemonade, 
lavements, and emollient fomentations to the abdomen, repeated 
every hour. The papillae of the tongue were prominent, the 
stomach painful on pressure, and there, was continual nausea. 

Being informed of the previous state of the patient, I thought 
it proper to combat the inflammation in the first place, and after- 
wards to employ the salt of quinine, or any other remedy that 
might appear proper, with the view to arrest the fever, after the 
disappearance of the gastritis, Twenty leeches were applied to 



412 PHYSIOLOGICAL PYRETOLOGY. 

the epigastrium; on the following day I prescribed a bath, after- 
wards leeches, fomentations, three lavements, with the water of 
mallows, and a rigid diet. The patient being much better in 
the evening, I ordered twenty, leeches to be again applied, and 
the fomentations to be continued after their removal. This was 
in the country: the leeches could not be immediately procured, 
and since I could not be consulted, the patient had them applied 
on the following day, at six o'clock; the usual hour of the parox- 
ysm was nine o'clock. I confess I would not have permitted 
the application of leeches on this day; having observed the 
worst effect to follow venesection, practised an hour before the 
paroxysm of a tertian fever. Returning in the middle of the 
day, I was much surprised to find the patient better, and with- 
out fever; I followed up this mode of treatment, which had been 
fortuitously commenced, applied six scarified cups to the chest, 
and, contrary to all rule, prescribed lavements, the bath, and af- 
ter the bath, fomentations, to be renewed every hour. The pa- 
roxysm did not return, and the pains in the stomach diminished 
so much, that the patient felt better than he had done since the 
commencement of his disease. This treatment was continued 
for eight days; during this time, forty leeches and numerous 
scarified and dry cups were applied. I afterwards advised a 
blister to the epigastrium, but the patient finding himself suffi- 
ciently restored, was unwilling to submit. A few days after, he 
left the place, the only remains of his disease being a state of 
weakness and leanness, which disappeared during a residence 
of two months in Piedmont, during which he was on a mild 
regimen. (t It is evident from this observation," adds M. Piol- 
let, " 1st, That before the administration of the bark, we must 
pay attention to the state of the stomach; 2ndly, That even during 
the existence of gastric irritation, this remedy arrests the fever, 
at the same time that it aggravates the local lesion; 3dly, That 
a gastritis may renew the tertian fever, after it has once disap- 
peared; 4thly, That by directing our measures against this gas- 
tritis we may dissipate the fever. 

In Corsica, M. Duplan administered the sulphate of quinine 
in lavements, with constant success, in the intermittent fever oc- 
casioned by the wind of Africa, after passing over the marshy 
plains of Almeria. But the employment of this salt must be 
preceded by general and local blood-letting, directing the latter 



INTERMITTENT FEVER. 413 

according to the seat of the inflammation, which determines the 
febrile reaction; this is easily determined by the sympathies 
which manifest themselves during the hot stage. It is at this 
period, likewise, that the abstraction of blood should be prac- 
tised; sometimes, however, M. Duplan applied leeches one or 
two hours before the cold stage; and in this manner he cured 
some fevers without having recourse to the sulphate of quinine: 
in this manner, too, the cure has been more promptly effected, 
and relapses have been less frequent. A soldier, who suffered 
from tertian fever, the paroxysms of which lasted about twenty 
hours, was treated in this manner, and cured. The inflamma- 
tion affected simultaneously the mucous membrane of the sto- 
mach, and bronchia. Two large applications of leeches to the 
abdomen mitigated the paroxysms, which at last yielded to the 
abstraction of eight ounces of blood from the arm, during the hot 
stage. Three men, who suffered from an intermittent of old 
standing, and who had made use of the sulphate of quinine, pre- 
sented the phenomenon of infiltration, although nothing of this 
kind was observed by M. Duplan, in those who had been treat- 
ed by local sanguine emissions, aided only by emollient regi- 
men. * 

At Calvi, in the same island, M. Gassaud has proved that in- 
termittent fever can be cured by sanguine emissions alone, or 
judiciously combined with revulsives, and he hence concludes, 
that the cinchona and its preparations are not specifics, t 

At Rochelle, M. Gaste has repeatedly cured intermittent fe- 
ver, without the employment of any other means than the anti- 
phlogistic treatment, indicated by pulmonary phlegmasia?. $ 

When intermittent fevers persist after sanguine emissions, 
we need not be so cautious in the employment of quinine; the 
bad effects which may follow the unseasonable employment of 
this remedy, are the less to be feared in proportion as the apy- 
rexia becomes more complete, the stomach free from irritation 
during the apyrexia, and the disposition to irritation observed 
by the abstraction of a certain quantity of blood. This method 
is peculiarly efficacious when a thoracic or encephalic irritation 
is the only, or the principal source of the disease. 

* Annals de la Medicine Physiologique, Aout, 1830. 

f Bibliotheque Medicale. December, 1827. 

| Journal Universel des Sciences Medicates, n. 149. 



414 PHYSIOLOGICAL PYRETOLOGY. 

Pinel recommends a drink, holding tartar emetic in solution, 
and the use of diluents during the first five or six paroxysms of 
gastric or bilious intermittent fever; to be followed by a little 
infusion, and he is said to have cured most of these diseases to- 
wards the eighth or tenth paroxysm. He very properly com- 
bats the opinion that bark is a specific in intermittent fever; he, 
however, permits it to be given as a tonic, either alone or in 
union with opium ; when the patient being very irritable, accord- 
ing to him, suffers from nausea or diarrhoea; with the nitrate or 
supertartrate of potash, in vigorous constitutions; with the mu- 
riate of ammonia, when there is an atonic state; finally, with a 
purgative after the paroxysm, when we wish to empty the 
primae viae. But he at least acknowledged, that it should not be 
employed when it produced colic pains, extreme malaise, and 
when it caused a kind of livid colour of the face, or, finally, 
when a painful swelling of the liver or spleen manifested itself. 

The remarks made in the third chapter of this work, with re- 
gard to gastric embarrassment, and continued gastric fever, ren- 
ders it unnecessary to discuss the propriety of evacuants in in- 
termittent gastric fever. The same principles are applicable in 
both cases. It has, however, been remarked, that in intermit- 
ment fever relapses are common under the employment of pur- 
gatives, a fact that should discourage their use. Although it is 
remarked, that relapses are less frequent, when the cinchona is 
given in union with purgatives, there is never a sufficient reason 
to risk a return of the disease: diet and acidulated drinks are all 
the means requisite to restore the appetite. I shall only add, 
that if emetics and purgatives sometimes cure intermittent fe- 
vers, it is because they are given in the apyrexia, and this ex- 
plains why they are in general less injurious in these fevers, 
than in continued fevers. 

Previously to the employment of bark in gastric intermittent 
fever, leeches should in every case be applied to the epigastrium, 
because there is always irritation of the stomach or duodenum, 
or of both these viscera. The region of the transverse and de- 
scending colon should be carefully examined, with the view of 
ascertaining whether it participates in the morbid condition of 
the stomach; it is particularly necessary to take this precaution 
when there is no symptom of irritation of the stomach or duo- 
denum. If it be thought that there is inflammation of the colon. 



INTERMITTENT FEVER. 415 

which is indicated by pain in the course of this intestine, and by- 
diarrhoea, leeches should be applied in great numbers to the 
anus. Some facts induce me to believe, as I have already re- 
marked, that inflammation of the colon is sometimes sufficient 
to determine intermittent fever. Should this prove to be the fact 
more frequently than I am at present aware of, it would account 
for the cases in which purgatives cause a relapse of the disease, 
while emetics cure. M. Roche has five or six times seen cases 
of intermittent colitis, accompanied with diarrhoea, likewise in- 
termittent. The facts which I have mentioned, lead me to be- 
lieve that this colitis may exist without diarrhoea, or that inflam- 
mation of the small intestines without gastritis, may personate 
colitis, and occasion a painful sensation of a bar extending from 
flank to flank. 

When the irritation of the digestive passages ha3 been suita- 
bly combated by the application of leeches rather than by vene- 
section; when, during the apyrexia, the tongue is perfectly clean 
and free from redness of its borders or point, the bark is to be 
administered in substance in doses which are not very conside- 
rable; for example, one or two drams. If, in the following apy- 
rexia, the tongue resumes its natural condition, we may continue 
its employment without danger, or even increase the dose until 
the paroxysms cease, or the gastric irritation tends to become 
continued. In the latter case, we must suspend the employment 
of the medicine and sometimes even return to the topical ab- 
straction of blood. 

It is in this manner, by a course dictated, not by the chimeri- 
cal idea of intestinal saburra, but by the state of the organ to 
which we address the medicine which is to complete the cure, 
that we avoid the obstruction of the liver and spleen and the 
prolongation of the fever, accidents which even to the present 
day have remained unaccountable, or which have been vaguely 
attributed to the action of the bark, although they should be at- 
tributed solely to the imperfection of the medical art. 

The treatment of intermittent mucous fevers differs little from 
that of gastric or bilious intermittent, with this exception, that in 
the former, the irritation being generally less intense, and the 
subjects being more weak and less irritable, bitters and quinine 
may be administered sooner and in larger doses than in the lat- 
ter, with less fear of causing the disease to assume the continued 



416 PHYSIOLOGICAL FYRETOLOGY. 

type, or of occasioning in the viscera annexed to the digestive 
canal, a dangerous sympathetic irritation. It is, however, espe- 
cially after numerous paroxysms of intermittent mucous fever, 
that the viscera are observed to become affected, because the sub- 
jects in whom this fever is generally observed, although but lit- 
tle predisposed to acute inflammations, have a great tendency to 
contract the organic alterations which are the effect of an obscure 
and prolonged irritation. But if we reflect that intermittent ir- 
ritation of the digestive passages is a powerful cause of irritation 
of the liver, the spleen, and mesentery, we shall recognise the 
necessity of not delaying too long the exhibition of the bark. 

en the bark does not from the first, arrest the paroxysms 
of mucous intermittent fever, and especially when it aggravates 
them, we should still more than in gastric intermittents, appre- 
hend, not the approach of a fatal termination, but the develop- 
ment of a chronic and latent inflammation of one of the abdo- 
minal viscera. Whenever the bark seems to be rather injurious 
than beneficial, it is prudent to temporise until spring, the period 
at which mucous intermittents and almost all autumnal intermit- 
izz'.s. ■:.s~:l~.y :^:sz. 

But, it is in vain to expect a radical cure from any mode of 
treatment whatever, as long as the subject remains in a damp at- 
mosphere impregnated with marsh-miasmata, the ordinary cause 
of these fevers. The same remark applies to gastric intermit- 
tents when they are attributable to the same cause. 

What shall we say of adynamic intermittent fever, sincf 
existence is hardly admitted by the nomologist who has establish- 
ed the class of adynamic fevers? There is but little wisdom in 
laying down a priori rules of treatment in diseases which per- 
haps do not exist. Should the physician, however, encounter 
such diseases in his practice, he should, in my opinion, treat them 
as gastro-enteritis of great intensity; since adynamic fever, pro- 
perly so called, that is to say, the putrid fever of the ancients, 
is evidently owing to inflammation. It is proper to remark that 
in the very limited number of adynamic intermittent fevers 
which have hitherto been observed, the bark has not appeared 
more efficacious, or rather it has not appeared less injurious than 
in continued adynamic fever. These fevers appeared rather re- 
mittent than intermittent. 

The cinchona is not the only remedial agent which we may em- 



INTERMITTENT FEVER. 417 

ploy in the treatment of intermittent fever. I have already re- 
marked, that many other remedies have been employed with 
success. 

At the head of the substances which have been proposed, as 
substitutes for the bark, stand the arsenical preparations. Au- 
thentic observations collected by physicians of known honesty 
and information demonstrate the efficacy of these preparations, 
not only in benign but also in pernicious intermittents. In my 
opinion, the physician should never employ poisonous substances 
unless the indications of cure cannot be answered by any other 
means. In speaking of the efficacy of arsenic, I do not wish to 
recommend it, but only to demonstrate that it partakes of the 
pretended specific properties of the bark. 

I am far from wishing to proscribe the employment, so fre- 
quently useful, of the indigenous bitters; but of all the means 
employed with a view to cure intermittent fevers, the bark is the 
one, the manner of administering which is least known; it is the 
most powerful of the remedies not derived from the class of poi- 
sons. It should be preferred to other bitters, because it com- 
bines many valuable properties, being both bitter and aromatic 
in a very high degree, and because the dose and action of this 
substance can be graduated with the greatest facility and certainty. 

The effects of the alkalies obtained from the cinchona, and of the 
salts which they form, not being as yet perfectly confirmed by 
experience, I think they should only be employed in the fol- 
lowing cases: 

1st, When the patient refuses to take the bark in substance. 

2dly, When the bark in substance is rejected by vomiting. 

3dly, When we have reason to think that it will be rejected, 
if administered in this manner. 

4thly, When the bark is ineffectual. 

5thly, When it cannot be procured of good quality. 

Such were the opinions, too timid, perhaps, but at least pru- 
dent, which I advanced in the first and second editions of this work. 
Experience has since convinced me that the sulphate of quinine 
may always be substituted for the bark, and that it possesses ad- 
vantages which render it preferable in all cases. The dose should 
be from four to ten or twelve grains; seldom more. This salt 
; acts precisely in the same manner as the bark, but it has not the 
inconvenience of bulk and of occasioning disgust; in too large a 

53 



418 PHYSIOLOGICAL PYEETOLOGY. 

dose it irritates or inflames the stomach in the same manner as 
the bark. 

The action of bark in intermittent fever, has been the subject 
of multiplied disquisitions; at the present time the theories on 
this subject may- be reduced to three. — Some assert that it acts 
as a specific: I confess I can understand absolutely nothing from 
such an assertion, and I abandon to more able hands the elucida- 
tion, the discussion, and especially the demonstration of its spe- 
cific character. Others think that it cures intermittent fevers by 
augmenting the vital forces: I do not believe that the vital forces 
are susceptible of an absolute augmentation: is it a local augmen- 
tation of the organic movement that is meant? Is it meant that 
it strengthens the stomach? This opinion is equivalent to that of 
those physicians who think with reason that it cures intermit- 
tent fever by stimulating the digestive mucous membrane, as it 
stimulates it in all the other cases in which it is administered. 

It being determined that bark cures intermittent fever by 
mutating the stomach, some have thought it a legitimate conclu- 
sion that the intermittent fever is not a gastritis; for, say they, 
how can an irritant cure an irritation? M. Broussais asserts that 
it is by opposing irritation to irritation: this is equivalent to not 
answering the question at all. 

We have now arrived at the point of the new theory 
most litigated; I must therefore be permitted to dwell upon the 
subject, as much as its importance demands. 

Let it be granted in the first place, that two facts, which have 
been demonstrated, do not cease to be true, even when we are 
ignorant of the manner in which one follows the other, and that 
the want of a good explanation of the connexion which subsists 
between them, and even the apparent contradiction, which may 
result from the want of explanation, does not authorize us to 
deny their existence. This principle being laid down, I might, 
in strictness, only add — gastric intermittent fever is evidently an 
irritation of the digestive passages: the bark augments vital ac- 
tion in the tissues with which it is placed in contact: this fever 
very frequently ceases after the administration of this remedy i 
it is not incumbent upon me to endeavour to reconcile this con- 
tradiction, which must be only an apparent one, for in nature there 
is no contradiction. The physicians who pretend that the inter- 
mittent fever is cured by the specific action of bark, elude the dim- 



INTERMITTENT FEVEIl. 419 

culty which they oppose to us; they deny the stimulant action 
of bark when they are defending their own theory, while, with 
the view of opposing ours, they assert this action. I think that 
without creating any hypothesis, or resorting to any suhtilty, we 
can explain the action of bark even in gastric intermittcnts as 
well as the action of any other therapeutic agent, in other dis- 
eases: We shall only generalize facts. 

In the case in which it succeeds best, bark is applied to the 
stomach during the apyrexia, consequently when the stomach is 
not irritated: first fact. 

The bark does not succeed, or it acts but imperfectly when 
it is given, while the stomach is still irritated: second fact. 

Bark aggravates the state of the patient when it is given too 
near the invasion of the paroxysm; still more when it is given 
during the paroxysm; in the former case the stomach is already 
greatly irritated; in the latter it is irritated in the highest degree: 
third fact. 

From these three facts, I draw the conclusion, that bark cures 
gastric intermittent fevers, because it excites the stomach in the 
absence of the irritation, which manifests itself by the febrile pa- 
roxysms. This proposition is only the general expression of 
the three facts which have been indicated. 

It remains to examine how the remedial excitation which the 
bark develops in the stomach, prevents the development of the 
morbid excitation, which having established itself in this organ, 
determines the febrile symptoms, and how it acts when the irri- 
tation of the digestive passages, which gives rise to the febrile pa- 
roxysms, continues during the apyrexia, and when it is ad- 
ministered during the paroxysm. I might answer that the bark 
acts by producing a specific irritation, or I might say, that this 
fact is not more extraordinary than the death of so many men, 
victims of this irritation, added to the permanent irritation of 
the stomach in continued fever. But, 

1st, Continued inflammations are cured by the direct applica- 
tion of stimulants to the part inflamed: in this manner ophthalmia 
is cured by alum, urethritis by the sulphate of zinc, erysipelas 
by a vesicatory. — If a continued irritation be cured by an irri- 
tant, why should not the same thing occur, and even more rea- 
dily in case of an intermittent irritation, especially if the irritant 
be applied during the absence of the irritation? 



420 PHYSIOLOGICAL PYRETOLOGY. 

2dly. An intense irritation provoked in an organic tissue 
prevents the development of one less intense, and renders it in- 
sensible to the impression of a less powerful irritant; the locali- 
zant action, (action localisante) of an astringent tonic may cause 
the cessation of the generalizant action, (action generalisante) of 
an expansive excitant. Thus, when the mucous membrane of 
the mouth has been rendered burning and painful by the action 
of pepper, the strongest brandy seems to be only a mild liquor, 
vinegar is scarcely perceived, and bitters appear to have no taste. 

Sdly. If it be true that continued fever is a preventive of in- 
termittent fever, it is with reason that Pujol says that bark 
cures intermittent fever by creating a sort of continued fever. 

4thly, When the stomach is not the seat of irritation, bark 
cures the intermittent fever as it cures a periodical ophthalmia, 
neuralgia, or any other external intermittent irritation. 

5thly. Bark cures intermittent fever, either by establishing in 
the stomach an irritation which prevents the impression on this 
organ of the causes of the disease, when they operate through it, 
or by determining a derivative excitation in the stomach, when 
the morbific influence directs itself to some other organ. 

6thly. If it be maintained that quinine acts as a specific against 
periodicity, habitude, inter mitt ence, it must be granted that it 
shares this property with the passion of joy or terror, with arse- 
nic, opium, hyosciamus, tartar emetic, and many other agents 
which cure periodical diseases. 

Let us cease to search in facts for what can never be disco- 
vered in them: an agent produces a certain effect in certain tis- 
sues, and the result is the cure of a certain disease: this is the 
amount of our knowledge, not only with regard to bark, but 
also with regard to all therapeutic agents. Let us not seek in 
the action of medicines for arguments against the demonstrated 
nature of diseases. 

Regimen is of great importance in intermittent fever; igno- 
rance of the proper mode of directing this part of the treatment 
is the cause of the indefinite prolongation of the disease which is 
s© frequent. In the apyrexia the subject should eat little, and 
only use such articles as do not tend to accelerate the circulation, 
by nourishing too highly, or by stimulating the stomach. The 
indication of stimulating the stomach should not be answered 
except by bitters, the martial preparations, or bark; because 



INTERMITTENT FEVER. 421 

these arc the only agents which exercise a tonic action without 
accelerating the contractions of the heart. 

If during the apyrexia the tongue is red on its borders, and 
the epigastrium painful, the nourishment which is necessary 
when the disease prolongs itself, must keep up the irritation of 
the stomach, and neutralize the good effects which the sudden 
and intense action of quinine produces in all other cases. Since 
it is impossible to confine the patient for a considerable time to 
a very rigid diet, we must at least endeavour to render the gas- 
troenteritis completely intermittent by the topical abstraction of 
blood, a measure which requires the most complete abstinence 
during the whole time of its employment. 

The patient should eat very little, or even abstain entirely 
during the morning of the paroxysm. If the paroxysm occurs 
at an early hour, the most complete abstinence is indicated. A 
few moments before the accession, it is proper to administer, ac- 
cording to the advice of Stoll, a hot drink slightly aromatic, and 
to employ the preservative means which have been mentioned: 
the vapour-bath would, no doubt, be of great advantage, under 
these circumstances. 

The effect of diet is much aided by the employment of aqueous 
drinks, taken very hot, and topical depletion. These means 
united suffice more frequently than it is generally believed for 
the cure of intermittent fever. Let the world enjoy the wit of 
Le Sage at the expense of Doctor Sangrado; let us not fear the 
application of this title: our success will indemnify us for the 
ignorant malice of the public, the malevolence of some of our 
medical brethren, and the interested sarcasm of the apothecary. 

I have said that the morbid organic state which constitutes in- 
termittent fever ceases during the intermission; this, however, 
is only true in general; sometimes it only diminishes, and de- 
scends to a degree, at which it does not call the sympathies into 
play; this happens particularly in chronic gastric intermittent 
fever. In many cases of recent intermittent, the intermission is 
far from being exempt from all morbid phenomena. These fe- 
vers resist the bark, which is then often abundantly administered 
without any effect. It is in these cases that bark occasions ob- 
structions; it is in these fevers, especially, that regimen and the 
antiphlogistic method properly conducted, exercise, the fresh 
air, and baths are useful. 

A measure which is little known, formerly recommended by 



422 PHYSIOLOGICAL PYRETOLOGY. 

Silvius, and employed with success by M. Lallemand, is the 
employment of ligatures applied tightly round the limbs. It is 
much to be desired that we were in possession of a greater num- 
ber of facts in relation to this subject. 

I believe I have shown that intermittents, particularly those 
of benign character, naturally find their place in the new theory, 
particularly if we do not consider these diseases as so many gas- 
tro-enterites. This theory, as I have explained it, should, I 
think, methodize the treatment of benign intermittent fever, and 
we shall soon see that it may lead to the successful treatment of 
pernicious intermittents. The treatment of these diseases has 
been abandoned to empiricism, only because the ancient theory 
was based upon hypothesis instead of facts, and was of no prac- 
tical utility. 

The strong hold of the adversaries of the new doctrine is the 
theory of intermittent fever. They think that they have accom- 
plished every thing when they have said, Bark cures these fevers; 
they are therefore not inflammations. If bark always cured, if 
it were never injurious, this determined opposition would be of 
little consequence. But this is not the case; it often fails, at least 
in those cases in which intermittents constantly prevail. It 
sometimes does injury, or our masters had less wisdom and abi- 
lity than certain practitioners of the present day, who always 
cut short the fever with the sulphate of quinine. It is therefore 
necessary to investigate the nature and seat of intermittent fever; 
for the better we are acquainted with an effect, with the more 
ease and certainty should we be able to obviate it. We do not 
pretend to impose our doctrine upon others, but we shall conti- 
nue to consider it as good, if not perfect, until a better one is 
discovered; and we do this the more boldly, since, notwithstand- 
ing all that has been said by persons who do not read at all, or 
who read with prejudice, or who do not comprehend what they 
read, this doctrine excludes no fact, and accords completely with 
experience. 

Physicians inhabiting countries in which intermittents prevail 
are very culpably indifferent: they alone have been called upon 
to pronounce with regard to the nature and seat of these diseases: 
hardly any among them have answered the appeal which was 
made to them in the first edition of this work. Most of them 
adhere to the old therapeutic routine, or they have modified their 
opinions to a certain extent without any improvement in their 



INTERMITTENT FEVER. 423 

practical views. Let them at length shake off this pernicious 
apathy, and imitate MM. Bally, Duplan, Gassand and Gaste. 

Macintosh docs not think that blood-letting, practised during 
the cold stage necessarily occasions death, notwithstanding the 
opinion of many respectable authors. According to him, the 
intermittent sometimes yields to this mode of treatment, the ac- 
tion of which breaks the succession of morbid phenomena, and 
renders the following paroxysms successively less violent. Blood- 
letting, in every case in which he practised it during the cold 
stage, cut short this period, and prevented the hot and sweating 
stages, which were entirely wanting. This means appeared to 
him to act by preventing the natural efforts of the economy, by 
opposing the congestion which takes place in the viscera, and by 
restoring the equilibrium of the circulatory system. " We may," 
he remarks, expect to derive advantage from this measure in the 
treatment of the grave intermittents of autumn, and more parti- 
cularly in the pernicious and malignant intermittents of Italy, 
Holland, and other marshy countries. Blood-letting may be 
employed with safety in every country when the cold stage con- 
tinues for a long time, and presents some danger. This opera- 
tion is always more useful in the cold than in the hot stage, or 
in the intermission. It never prevents the paroxysm when 
practised during the intermission." Finally, M. Macintosh 
goes so far as to propose blood-letting in the first period of all 
fevers. He had himself bled with success in the cold stage of an 
intermittent contracted in a marshy country, and which had re- 
sisted the quinine and other remedies. Before he had lost two 
ounces of blood from the arm, the rigor ceased, as well as all the 
other symptoms of malaise Which accompanied it, and neither 
the hot nor sweating stage succeeded. The painful sensation of 
cold was succeeded by an agreeable warmth, and the strength, 
instead of diminishing, was restored. The same means succeed- 
ed in numerous cases. The number of facts in support of this 
practice are not yet considerable.* We would not deny the au- 
thority of facts; nevertheless, the employment of blood-letting 
in the cold stage appears to us hazardous in pernicious fever, and 
we do not think the measure should be resorted to except in be- 
nign intermittents, and even in them with prudence, and only in 
very vigorous subjects. 

* Journal des Progres, tome iii. 1827. 



424 PHYSIOLOGICAL PYRETOLOGY. 



CHAPTER XII. 



Of Pernicious Intermittent Fevers. 

Pinel had only indicated the place which pernicious fevers 
should occupy in his nosological classification, when Alibert pub- 
lished a treatise on these diseases, in which he not only present- 
ed a summary of the observations collected by Mercado, Mor- 
ton, Torti, Lautter, Lancisi, Comparetti, but likewise described 
many new varieties of these fevers.* His work shall serve me 
as a guide in the exposition of the phenomena of these diseases^ 
as well as of the treatment recommended and employed with fre- 
quent success by the most skilful practitioners. 

Intermittent fevers do not always continue with as little inten- 
sity as those which have been mentioned in the preceding chap- 
ter under the denomination of mucous, gastric and inflammatory 
intermittents. Under certain circumstances, we observe a change 
in the character of the disease, at the second, third or fourth 
paroxysm. The rigor becomes shorter and very intense, or it 
becomes very long: instead of the phenomena of the hot stage, 
we sometimes observe grave symptoms, which have not hitherto 
manifested themselves; at other times, one or more of those 
which already appeared become remarkably exasperated; the 
sympathetic phenomena which particularly characterize the fe- 
brile paroxysm become less apparent, or they even disappear. 
The local symptoms of irritation, until now frequently unper- 
ceived, become so prominent that they cannot be mistaken, and 
we observe all the phenomena of a formidable acute disease. Yet 
the paroxysm terminates by a sweat of little importance, the pa- 



* Traite des Fievres Pernicieuses Intermittentes, 5th edition, Paris, 1820, 
8vo. 



INTERMITTENT FEVER. 425 

tient partially recovers his strength and appetite, and sometimes 
does not complain of any malaise. A new paroxysm occurs, and 
if the fatal termination does not take place in this paroxysm, it 
i seldom fails to supervene in the succeeding one, though some- 
times in the fourth or fifth paroxysm, without counting those in 
which no unfavourable symptoms manifested themselves. Such 
; is the course of the phenomena of pernicious intermittent fever, 
: when the proper treatment is not employed, or when it is in- 
effectual. 

It appears from facts, collected by able observers, that we 
should recognise a great number of varieties of pernicious inter- 
■ mittent fever, distinguished by their most prominent symptoms, 
! and the organs in which these symptoms manifest themselves, 
\ and that we may distribute them under different heads, accord- 
; ing as the symptoms denote an affection of the digestive pas- 
sages, of the encephalon, of the lungs or pleura, of the heart, 
the uterus, the kidneys, the bladder, the extremities, or the skin: 
whence result the following varieties of pernicious intermittent 
fevers: 1st, The cardialgic, atra-bilious or hepatic, coleric, colic; 
2nd. Cephalalgic, soporose, delirious, convulsive, epileptic, hy- 
drophobic, aphonic, paralytic; amaurotic; 3d. Peripneumonic, 
pleuritic, catarrhal and dyspneeic; 4th. Syncopal, and carditic; 
5th. Uterine; 6th. Nephritic, and cystic; 7th. Rheumatic; 8th. 
Algid, diaphoretic, exanthematous, and icteric. 

This division must not be considered as an attempt at classi- 
fication; it is simply an arrangement of pernicious fevers, ac- 
cording to the organ in which the most prominent symptom ma- 
nifests itself: we shall presently see that this arrangement is only- 
provisional. 

1st, The pernicious cardialgic fever, the most frequent of all, 
and one of the most formidable, perhaps even the most dan- 
gerous, is characterized by an acute pain in the epigastrium, 
which appears to correspond to the superior orifice of the sto- 
mach. There is a sense of biting, of insupportable laceration, of- 
ten accompanied with nausea and even vomiting, sometimes with 
syncope. The pain may be so intense, as to draw cries from the 
patient; the face is pale, the features profoundly altered, the 
pulse small, unfrequent, scarcely perceptible, the muscular force 
prostrated, the vision sometimes obscure, and respiration often 
embarrassed. These symptoms manifest themselves after a rigor, 

54 



426 PHYSIOLOGICAL PYRETOLOGY. 

generally of short duration, or at the commencement of the hot 
stage. If we compare this state with acute, or chronic cardial- 
gia, of a non-febrile character, and with certain continued gas- 
tric fevers, we shall be convinced that this variety of pernicious 
gastric fever is only an intermittent gastritis, of great intensity. 

The atra-bilious or hepatic, has been observed only in a small 
number of persons of vigorous constitutions: it has appeared 
less grave than many others. It is announced by abundant and 
repeated alvine dejections, composed either of matters resem- 
bling the washings of flesh, or of blackish blood, either liquid 
or coagulated, in whole or in part; the weakness is extreme, the 
pulse feeble and small, the voice shrill or lost, the body is cold, 
especially the extremities, and the patient is threatened with 
syncope, whenever he attempts to rise. All these symptoms 
indicate a violent intermittent irritation of the intestines, with 
sanguine exhalation, more or less abundant. The time is gone, 
when the matters passed in this disease were considered as de- 
rived from the liver. 

The symptoms of the choleric or dysenteric, are a vomiting 
of abundant bilious matters of a porraceous green colour, heat, 
and acute pain of the stomach, dryness of the tongue, hiccough, 
alterati'on of the voice, which becomes either shrill or hoarse, 
embarrassed respiration, smallness and feebleness of the pulse, 
lividity and coldness of the extremities. Notwithstanding all 
that has been said by Torti, we can only see in this affection an 
intermittent cholera; that is to say, a violent irritation of the sto- 
mach and intestines, occurring periodically, and accompanied 
with evacuations exceedingly abundant. 

The colic observed by Morton, has for its pathognomonic sign, 
acute pains in the intestines, which consist sometimes in a very 
unpleasant sensation of twisting, or tension, or in a kind of tre- 
mor with small pulse, extreme anxiety, spasm, vomiting, cold 
sweat, thirst, dryness of the tongue. The last two symptoms 
do not always occur, a fact which I have had an opportunity of 
ascertaining with certainty. 

These four pernicious fevers, present examples of the princi- 
pal shades of intermittent gastro-intestinal irritation, carried to 
the highest degree of intensity, and exercising over the ence- 
phalon the most powerful influence. Collectively, they consti- 
tute the greatest number of pernicious fevers, a fact which con- 



INTERMITTENT FEVER. 427 

firms the remarks which have been made, with regard to the 
great frequency pf gastric intermittent fevers in general. The 
local symptoms, which have but little prominence in benign in- 
termittent:*, manifest themselves with such intensity in the per- 
nicious gastro-intestinal intermittents, that the seat of the dis- 
ease cannot be mistaken. 

2nd. Authors who have observed the ccphalalgic pernicious 
fever, assert, that to the symptoms of vascular reaction, are joined 
an acute pain of the head, particularly in the frontal region, some- 
times a hemicrania, often pain in the orbits, troubled vision, an 
excessive irritability of the retina, tinnitus aurium, great sensi- 
bility to every kind of noise, vertigo, and insomnia. All these 
phenomena indicate an irritation of the arachnoid, of the most 
intense character, of which the encephalon partakes to a greater 
or a less degree; these facts admit of no doubt. It is to be re- 
gretted, that the state of the stomach and tongue has not been 
described with care, in this variety of pernicious fever. Very 
subject myself to intense, but transient irritations of the ence- 
phalon, I am convinced that their influence is almost always felt 
by the stomach; a single fact, however, is never conclusive. 
The suspension of business for a single day, is sufficient to restore 
the functions of my stomach, although my head continues pain- 
ful, and I still suffer from vertigo; a proof that this cerebral irrita- 
tion is primitive. Comparetti reports the history of a case of 
cephalalgic pernicious fever, accompanied with deafness, and a 
sense of beating in the ear, a painful sensation of constriction 
in the back of the neck, prostration, failing of all the senses, 
torpor of the intellectual faculties, incapacity to support the 
slightest noise, or light. The symptoms of this pernicious fe- 
ver were certainly the effects of an encephalic irritation; for al- 
though the bark moderated the paroxysms, it did not produce a 
cure until after the discharge of a purulent matter from the au- 
ditory canal: a black spot indicated the caries of the osseous pa- 
rietes of this canal. 

Nothing resembles the pernicious fever more than the perio- 
dical attacks of violent cephalalgy, caused by a profound lesion 
of the encephalon, of which M. Itard has reported several ex- 
amples.* This physician, who does not fear to advocate the 

*Traite des Maladies de l'Oreille et de l'Audition. Paris, 1822. 



428 PHYSIOLOGICAL PYRETOLOGY. 

new doctrines, confirmed by his experience, has published tn 
interesting memoir, in which he establishes the following pro- 
positions, which he deduces from facts: 

An acute or chronic inflammation of the meninges, or of the 
encephalon, may manifest itself only by intermittent symptoms. 

The fever known by the name of ataxic intermittent is, in 
certain cases, the number of which will, doubtless, be found to be 
greater as observation becomes more extended, only a sympto- 
matic fever excited by the phlegmasia of the brain. 

The transition from intermittent to continued fever, in pro- 
portion as the disease becomes aggravated and approaches the 
fatal termination, is a proof that the type of the fever serves less 
to establish its character or nature than to indicate the degree of 
intensity of the phlegmasia which provokes it* 

The apoplectic , car otic, lethargic, comatose, or soporose 
pernicious fever, is one of the most frequent after the cardialgic: 
it is perhaps the most dangerous, and at the same time one df 
those which yield most readily to treatment. Towards the ter- 
mination of the rigor, or during the hot stage of benign intermit- 
tent, the patient falls into a state of somnolence, or even into a 
state of torpor more or less profound: the pulse is full and unfre- 
quent, or small and slow, the eyes are suffused and fixed, the 
eyelids half closed and motionless; the face assumes a cadaverous 
aspect; if the patient be aroused, he utters a few words in a stam- 
mering manner, and hardly answers the questions which are 
put to him: regardless of what passes around him, he asks for 
something and instantly forgets it; he is aware of the incoherence 
of his ideas, endeavours to collect himself, but soon relapses into 
stupor. When the paroxysm is very intense, the respiration is 
stertorous, all sensation seems extinct; and there is neither 
speech nor movement. After one or two hours passed in this 
state, the patient recovers his consciousness until the next pa- 
roxysm occurs. Each of these paroxysms then present, some- 
times, the phenomena of continued apoplexy, and at other times 
those of the stupor, which characterizes typhus. — In both cases 
these phenomena are proofs of a strong concentration of vital ac- 
tion towards the encephalon, of a manifest or latent afflux of 

* Memoires sur quelques Phlegmasies Cerebrales, presentees corame cause 
de Fevres Intermittentes pernicicuses; insere dans le Journ. Univer. des Sc. 
Med. xxxii. p. 366, 367. 



INTERMITTENT FEVER. 429 

blood to this organ; an afllux which, as Dcvcze has shown, is 
only the effect of an irritation of the cerebral substance.* This 
afflux not being at first sufficiently violent to determine extrava- 
sation of blood in the brain, a state of calm is restored until a 
new attack at length exhausts the vital activity which belongs to 
this organ. 

The state of the tongue and stomach, which doubtless partici- 
pate, at least in most cases, in the irritation of the encephalon, 
has not been described in this fever. 

The delirious pernicious intermittent is not characterized by 
disorder of the intellects alone: the thirst is ardent, the skin very 
hot, the pulse very weak, the sphincter of the bladder some- 
times relaxed, the patient struggles to leave his bed. — In a case 
reported by Lautter, there were in addition, all the signs of an 
inflammation of the lungs. In one of two cases observed by 
Lanoix, the face was red and animated, the tongue of a brownish 
red at its centre, and bordered with yellow. Whenever the pa- 
tient drank he vomited, with terrible efforts, bile of a porraceous 
green hue, and by his gestures indicated the pain which he felt 
at the epigastrium; respiration was embarrassed, the pulse small 
and profound, stupor terminated the paroxysm, which lasted 
eighteen hours. During the apyrexia there was still nausea; the 
memory was slightly affected. The paroxysms were renewed 
with increased intensity, and the sixth only ceased with the life 
of the patient. In another case, pains of the head and dyspepsia 
announced the paroxysm, which commenced with a violent rigor 
which lasted forty-eight hours; delirium supervened with feeble- 
ness of the muscles, redness of the face, embarrassed respiration, 
intense thirst, nausea, anxiety, concentrated pulse. There were 
but six paroxysms after the last, of which the patient recovered. 
We may conclude from these facts, that the delirious variety is 
seldom the effect of a simple cerebral irritation, and if we com- 
pare it with the analogous cases of ataxic continued fevers, we 
shall perceive that it is often a gastro-enteritis, with sympathetic 
irritation of the encephalon. I am, however, far from denying 
the possibility of a fever of this character, derived solely from 
irritation of the brain, or rather of its meninges. It should be 
remarked that the delirium has frequently been succeeded by 

* Recherches sur la Sensibility. Paris, 1786, in 8va 



430 PHYSIOLOGICAL PYRETOLOGY. 

stupor: this fever was then both delirious and soporose. It is 
possible to establish a well marked line of demarkation between 
affections which differ only as it respects individual predisposi- 
tion, the number of organs affected, and the intensity of their 
lesions. 

The convulsive variety is more common among infants than 
among adults; it is recognised by irregular contractions of the 
muscles of the face, a forced rolling and contortion of the ball of 
the eye, the dilatation of one or both pupils, sometimes by tris- 
mus; the stupor alternates with these symptoms or succeeds 
them ; respiration is much embarrassed and the pulse extremely 
small. This fever can scarcely be distinguished from the two 
preceding, and it furnishes a new argument for those who assert 
the inutility of multiplying species which differ so little from 
each other, that they are liable to be confounded. As in the 
preceding case, it is probable that the stomach is often irritated; 
but this could not be proved, because the signs of the irritation of 
this organ were not well known. The cerebral symptoms are 
here so prominent, that we cannot refuse to recognise in this 
shade of pernicious fever, a cerebral irritation, with or without 
gastro-enteritis, and accompanied with convulsive movements. 

The epileptic variety has been described by Lautter, who ob- 
served it once in a little girl. In the first paroxysm, after a ri- 
gor and a sensation of cold of short duration, there supervened 
.excessive heat, general convulsive movements, foaming at the 
mouth; the patient afterwards fell into a stupor. The return of 
the attacks at the same hour, indicated the type of this disease, 
which was cured, after three paroxysms, by an appropriate treat- 
ment. Lautter observed so little difference between the symp- 
toms of this disease and those of epilepsy, that he thought the 
disease was the latter, until the regularity with which the pa- 
roxysms returned, was mentioned to him. This variety is evi- 
dently a cerebral irritation, which manifests itself by symptoms 
of regular periodical epilepsy. 

The hydrophobic variety has been observed by Dumas. The 
case of which this author has given the history, was that of a ro- 
bust man of a dry complexion, w T ho, after having lain upon the 
damp ground, suffered from vertigo, intolerable headache, and 
general uneasiness; these symptoms were succeeded by a rigor, 
moderate heat, dejection and complete prostration. On the fol- 



INTERMITTENT FEVEK. 431 

lowing day the pain of the head continued in an intolerable de- 
gree; greenish matters were discharged by vomiting. On the 
next day a new rigor in the evening, intense heat, very ardent 
thirSt, irritation of the pharynx, causing embarrassed deglutition; 
slight delirium. On the succeeding day, no fever, prostration, 
somnolence, pain in the muscles of the neck; in the evening, 
pulse irregular, heat of the skin not preceded by rigor nor fol- 
lowed by sweat. Finally, on the following day, violent heat, 
furious delirium, convulsive movements of the lips and muscles 
of the neck, considerable difficulty of deglutition — constriction 
of the pharynx, augmenting on the approach of liquids; tongue 
dry, black in its centre, of a bright red on its edges. On the 
following day, a state of calm, but an aversion for liquids and 
difficulty of deglutition. On the following day general convul- 
sions, subsultus tendinum, violent constriction of the abdominal 
muscles, great difficulty of deglutition, furious delirium, at- 
tempts to bite, fojfming at the mouth, grinding of the teeth, in- 
vincible horror for all liquids, universal shivering on exposure 
to the cool air. The patient was treated by bark, and was 
cured after the eighth attack. His repugnance to liquids conti- 
nued even during the apyrexia. 

We cannot mistake, at the present day, the combined symp- 
toms of gastritis and arachnitis in this pernicious fever. Dumas 
has observed this interesting case with most laudable attention: 
he has noted the redness of the edges of the tongue, which a less 
attentive observer would not have mentioned; it is owing to the 
prejudices and inadvertence of physicians, that a great number 
of remarkable facts are given to the world in an imperfect man- 
ner. 

The aphonic variety of which M. Double has given us the 
history, was not observed with less attention by this physician. 
Great heat, total loss of voice, convulsive agitation of the muscles 
of the face, a tongue as it were burnt, extreme thirst, a general 
sense of uneasiness, of pain and of weight characterized the pa- 
roxysms, which were few in number, and the disease terminated 
happily with the aid of bark. After these symptoms, we cannot 
doubt that the stomach and brain were greatly irritated. But 
the fever was not only aphonic, it was likewise convulsive, and 
the intermittent inflammation of the stomach was not for a sin- 
gle instant equivocal. 



432 PHYSIOLOGICAL PYRETOLOGY. 

The paralytic observed by Molitor and Jonquet,* the amauro- 
tic which has been observed by Vacca Berlinghieri, are only va- 
rieties of the pernicious fever, in which the brain is irritated ei- 
ther primitively or sympathetically: they are unfrequent, and 
yield as readily as the other varieties to the administration of 
bark. Sometimes, on the contrary, amaurosis succeeds the em- 
ployment of bark and the cessation of the paroxysms: M. Cou- 
tanceau has observed a case of this kind, in which the impairment 
of sight was transient. 

Cerebral irritation predominates in these nine varieties of per- 
nicious fever; by whatever symptoms announced, it is not equi- 
vocal: it is always of a threatening character, and calls for the at- 
tention of the physician. This irritation is not always combined 
with an analogous state of the digestive passages. To suppose 
that irritation is always a sympathetic symptom of gastroenteri- 
tis in these fevers would be incorrect; it is facts of this kind which 
demonstrate that pernicious intermittent fever is hot always a gas- 



* A gardener aged seventy years, of strong and robust appearance, was, af- 
ter a transport of rage, attacked with insensibility, and fell into a profound 
stupor; a surgeon immediately prescribed tartar emetic and irritating lave- 
ments. After the operation of these remedies, he ordered blisters to the in- 
ternal and upper parts of both thighs, recollecting that the patient had for 
some time been without an herpetic disease, with which he had been affected 
for many years along the spinal column. Doctor Richard found the patient 
in a soporose state, stammering whenever he Was forcibly awakened; his 
mouth was greatly distended, his respiration appeared much embarrassed, his 
pulse though irregular was tense, his face was highly animated ; venesection 
was practised, and a purgative lavement administered immediately after- 
wards. On the following day, the surgeon finding the patient very well, or- 
dered a purge. M. Richard found the patient in the state in which he had 
left him, with the addition of a hemiplegia of the right side, and convulsive 
movements of the parts around the mouth. He was informed that the pa- 
tient had during the night suffered great distress and even cold, and that he 
had asked for more covering. The urine was covered with a milky pellicle, 
and deposited a lateritious sediment; the prevailing diseases were almost en- 
tirely intermittent : he ordered a large blister to the back of the neck, and 
a sinapism to the sole of the feet; he gave at the same time by the spoonful 
a potion containing half a dram of camphor, and he prescribed for the time 
of intermission, an ounce of bark mixed with a dram of camphor. On the 
third day after, the patient had no paroxysm, and the hemiplegia had entire- 
ly disappeared with the fever; the bark was continued for some days. The 
patient, under this treatment, was soon restored to his usual health. 



INTERMITTENT FEVER. 433 

tro-cnteritis any more than benign intermittent fever. Yet we 
cannot too strongly advise all practitioners to neglect no oppor- 
tunity of determining the state of the digestive organs in diseases 
of so formidable a character. 

3d. The symptoms of the pernicious peripneumonic ox pleu- 
ritic fever, described by Morton and Lautter, are a violent chill, 
general cold and intense pain of the chest, augmenting in inspi- 
ration, dyspnoea, extreme weakness; the pulse is at first small 
and formicant, afterwards hard and frequent; there is generally 
cough, the thirst is often excessive, and the tongue dry. This 
fever, which is not common, is only an intermittent inflamma- 
tion of the pleura or lungs; and this is so true that on the first 
paroxysm it is always mistaken for a continued peripneumony 
or pleurisy; it is only when the symptoms are observed to cease, 
the apyrexia to be established, and the symptoms to return again 
that the disease changes its name. 

Laennec observed an existence of pernicious peripneumonic 
fever. The subject was a man thirty-five years of age, robust 
and muscular, he entered the hospital with a recent syphilis, the 
treatment of which had been imperfect. The sudorific ptisan 
and mercurial frictions were ordered. On the sixth day of his 
admission he had a paroxysm of intermittent fever of conside- 
rable violence, and he stated that he had had one on the evening 
of the day but one previous. A third paroxysm occurred on 
the third day after; but it was entirely different from the pre- 
ceding paroxysms. It commenced with a more considerable ri- 
gor, was accompanied with a violent headache, extreme dyspnoea, 
and hemoptysis. The chest having been explored about the 
middle of the paroxysm, the respiratory murmur was found unal- 
tered except at the root of the lungs, where it was masked by a 
rale crepitant well characterized, principally on the right side. 
Laennec, without hesitation, declared the disease a double pneu- 
monia in its initial stage: tartar emetic, six grains; sulphate of 
quinine eighteen grains, to be taken in three doses. The patient 
vomited a little and had but one stool; the next day, he thought 
himself cured. But as the rale crepitant had not entirely dis- 
appeared with the cessation of the febrile paroxysm, the two 
prescriptions were continued. The following paroxysm was 
very short; the rale crepitant was slightly developed, and tho 

55 



434 PHYSIOLOGICAL PYRETOLOGY. 

hemoptysis reappeared; but the fever had scarcely ceased, when 
all the symptoms disappeared, (that is to say, as soon as the dis- 
ease ceased, it no longer existed.) The tartar emetic was dis- 
continued on the fifth day, the respiration having become pure 
and natural; the sulphate of quinine was continued for some 
days. The patient was now cured of the fever, and the anti-sy- 
philitic treatment, which had been suspended, was resumed. 
Three weeks after, the intermittent fever reappeared; it was now 
jsimple and benign, and a few doses of the sulphate of quinine en- 
tirely arrested it; the patient remained six weeks longer in the 
hospital, and left it in good health. 

This fact is important, since Laennec demonstrated by the 
stethescope the existence of a peripneumonia giving rise to ter- 
tian febrile paroxysms of a pernicious aspect, and diminishing in 
the apyrexia. That this case may be properly appreciated, and 
lest it should be thought that the inflammation of the lungs was 
the effect, and not the cause of the fever, it should be remarked, 
1st, That Harvey found a thick blood engorged in the lungs, in 
dissecting subjects who had died in the cold stage of intermittent 
fever, after anhelation, sighing, prostration, a small, frequent, 
and irregular pulse; 2dly, That traces of inflammation found in 
the whole extent of the internal membrane of the trachea and 
bronchia, after poisoning by corrosive sublimate, have recently 
induced M. A. Devergie to believe that this salt acts also upon 
the lungs, although, as he remarks, experiments on animals have 
given no indication of this influence. Now, in the case which 
has just been mentioned, the patient was treated by mercurial 
frictions, and it was during this treatment that the peripneumo- 
nic fever was developed. The preparation of the metal was not 
the same; but it is not uncommon to observe acute or chronic 
inflammation of the lungs in venereal patients, treated by mer- 
cury under any form. On this subject I would refer the reader 
to the profound and able treatise of M. Jourdan on venereal dis- 
eases, in which all theoretical and practical questions relative to 
syphilis are laid down and discussed with equal talent and good 
faith. 

The cylinder of Laennec, so useful in detecting the pulmona- 
ry inflammations which often complicate gastro-enteritis and ce- 
rebral phlegmasia^ will be of still greater service in an investi- 



INTERMITTENT FEVER. 435 

gaticm of the scat of intermittent fevers; and there is every rea- 
son to believe that the employment of this instrument will show 
that peripneumony tlocs not occur only in pernicious fevers. 

Venesection, practised heforc the administration of the qui- 
nine, would have increased its remedial powers, and, perhaps, 
hy preventing- any farther paroxysms, would have rendered its 
employment unnecessary. 

We arc indebted to INI. Fleury for a remarkable case of perip- 
neumonie fever, or rather of tertian peripneumony. A man, for- 
ty-five years of age, of sanguine temperament, of well developed 
form, and high complexion, entered the hospital on the 17th of 
November, 1S'2S, to be treated for a bronchitis, to which he said 
he was very subject. Until the 24th of the same month, he 
presented nothing peculiar; but, on this day, he was seized w r ith 
acute and deep pain in the right side, with painful and anxious 
inspiration. The cough, which seemed to be relieved by de- 
mulcents, became frequent, and was accompanied with a consi- 
derable expectoration of sputa of yellowish red colour. The 
fever, from which he was suffering, had commenced with long 
and violent rigors. The sound given by the thorax, w 7 hen care- 
fully struck, was dull over the posterior and superior part of the 
lung, and auscultation proved that the organ was with difficulty- 
permeable to the air: demulcent ptisan, white looch, thirty 
leeches to the painful point, emollient cataplasms. The fever 
passed through the usual stages, and in the evening there was a 
copious diaphoresis. On the following day the apyrexia was 
complete; all the symptoms of pneumonia ceased, and the sputa 
became mucous, although still abundant. This state continued 
during the whole day; but, on the 26th, about four o'clock in 
the morning, the fever declared itself anew, by rigors as in- 
tense as those of the preceding paroxysm by dyspnoea, by a lan- 
cinating pain in the side; in a word, by all the symptoms of 
very intense pneumonia. As soon as a state of calm was re- 
stored, and the equilibrium of the vital forces re-established, to 
procure which, hot and demulcent drinks were administered, and 
bottles filled with hot water applied to the patient, the sputa be- 
came very bloody: twelve ounces of blood were taken, and the 
white linctus and cataplasms were prescribed. From this time 
M. Fleury suspected an intermittent pneumonia, and proposed 
to administer the quinine in the evening of the same day. The 



436 PHYSIOLOGICAL PYRETOLOGY. 

fever continuing, but with abated force, the quinine could not 
be administered. On the following day the apyrexia was com- 
plete; all the peripneumonic symptoms had disappeared, and the 
patient, restored to a state of perfect calm, thought himself out 
of danger. M. Fleury took advantage of the intermission, and 
ordered a clyster of the decoction of bark, to which ten grains 
of the sulphate of quinine were added; and in the course of the 
day he administered a febrifuge potion. The fever appeared 
again, but the sputa were only slightly streaked with blood, the 
rigor only manifested itself in the feet, and the pneumonic symp- 
toms presented nothing alarming. Simple lavements of the de- 
coction of quinine were continued for some time on the days of 
intermission, and emollients on the intermediate days, and the 
patient in a short time recovered his health. 

In the dyspnceic or asthmatic variety, the pain is of little in- 
tensity, or there is no pain, the difficulty of respiration exces- 
sive, suffocation imminent, no sputa, although the cough is very 
strong. The state of the heart not having been explored with 
care, and in many cases the oppression having continued after 
the cessation of the paroxysm, it is probable, under this name, 
benign gastric intermittents have been described, developed in 
subjects whose bronchia, lungs, or heart have been affected with 
some chronic disease. 

The catarrhal variety, described by Comparetti, differs little 
from the peripneumonic; although, in the case observed by this 
physician, the face, the throat, and the eyes were red, the cough 
dry, and more violent in the evening, the head painful, equally 
with the chest, and the taste depraved; convulsions and stupor 
supervened. What advantage is derived from assigning a parti- 
cular name, altogether insignificant, to an intermittent irritation 
of the bronchial mucous membrane, with sympathetic irritation 
at first of the digestive mucous membrane, and afterwards of the 
membranes of the brain? The latter organs are affected in eve- 
ry case of pernicious intermittent which attains a high degree of 
intensity. Irritation of the stomach and intestines is a very 
usual concomitant of irritation of the bronchial mucous mem- 
brane. 

We should in the pernicious fevers which arise from irritation 
of the respiratory organs, as well as in those derived from an ir- 
ritation of the encephalon, endeavour to dissipate the gastro-en- 



INTERMITTENT FEVER. 437 

teritis, because the continuance of the latter during the apyrexia 
may counteract the contralizant action {action contralisante) of 
the bark. 

4th. The sy?icopal is distinguished from the other varieties in 
which fainting occurs, by the fact, that in this disease the patient 
faints whenever he is moved, or attempts the slightest move- 
ment; he does not complain of pain, but of great weakness, his 
face and neck are covered with sweat, his eyes hollow and dull, 
pulse small, depressed, and frequent; syncope recurs every in- 
stant, no matter what precautions are taken. 

Should this variety of the pernicious intermittent fever be 
classed among those in which the heart is principally affected? 
I do not think so; although I conform to the general opinion, 
which considers the heart as the seat of the proximate cause of 
syncope. Syncope occurs because pulsations of the heart are 
suspended: but is not this suspension of the action of an organ, 
so little exposed to the direct impression of morbific causes it- 
self, the effect of a morbid state of the brain? The laws which 
preside over the action of the heart in a state of health, favour 
this opinion. 

The carditic pernicious fever, of which M. Coutanceau* has 
reported several cases, appears to be dependant, rather than the 
preceding upon an active irritation of the heart. One of the pa- 
tients complained, during the paroxysm, not only of violent pal- 
pitations of the heart, but also of a cruel pain, which resembled 
the sensation of a biting in this organ. This pain having at- 
tained a certain degree of intensity, determined that indefinable 
sensation which precedes and announces syncope; the patient was 
deprived of all his senses, except that of hearing; he heard what 
was said and wished to speak, but was incapable. During this 
state, the arterial pulse and respiration were suspended, the pul- 
sations of the heart were weaker and slower than usual. The 
attacks of syncope generally continued for a quarter of an hour, 
and they were longer in proportion to the interval between them, 
which continued an hour or two. The first pernicious parox- 
ysm which had been preceded by two others, so slight as to be 
scarcely perceptible, had been calmed by the application of 
leeches; bark and opium diminished the intensity of the third, 

* Notice 9iir les Fievres pernicieuses qui ont regne epidemiquement a Bor • 
deaux en 1809. Paris, in 8vo. p. 60. 



438 PHYSIOLOGICAL PYRETOLOGY. 

and a fourth did not occur. The two other cases, observed by 
the same author, cannot be considered as belonging to the cardi- 
tic Tariety ? because, although there was syncope, the patient did 
not experience that acute sensation of biting, of torsion, which 
the patient mentioned above, experienced in so high a degree. 

Maty not an acute pain in the superior part of the stomach, have 
been mistaken for a pain seated in the heart, or its connexions? 
If this was the case, the two last varieties are only shades of the 
cardialgic pernicious fever. 

5th. The uterine pernicious fever, either simple or with si- 
multaneous irritation of the stomach and uterus, has. I think, 
been observed by Gaillard. The paroxysms were characterized 
by vomiting and a metrorrhagy, which continued even into the 
apyrexia: the tongue was whitish, the face pale, the pulse small, 
concentrated, frequent, the abdomen tense and painful: the least 
motion renewed the vomiting and hemorrhage. A combination 
of fixed and diffusable stimulants of narcotics and tonics, ap- 
peared to determine the cure of this fever, in which the uterus 
was, perhaps, more affected than the stomach, although vomit- 
ing occurred: for it is well known how frequently this symptom 
is determined by an irritation of the uterus. 

6th. The nephritic, described by Morton, was so evidently the 
result of an irritation, excited in the substance of the kidnevs by 
the presence of calculi, that we are astonished to find this author 
endeavouring to discover an unknown proximate cause, when 
the true one was so obvious. The two patients had passed renal 
calculi. We find in the great work of Morgagni, several cases 
of death occurring with rapidity at the termination of the symp- 
toms, the collection of which presents what is observed in the 
diseases, to which the name of pernicious fever is given: in these 
cases, en dissection, calculi were found in the uterus and kid- 
neys. We may easily conceive, that an acute irritation of these 
parts may occasion an irremediable lesion of the brain, since the 
simple incision of the skin is sufficient, in a great operation, to 
render the patient delirious; since, also, death often follows this 
delirium. 

The cystic, described by M. Coutanceau, was primitively 
cardialgic; the pain of the stomach was replaced by a pain in 
the region of the bladder, a pain which was only relieved by 



INTERMITTENT FEVER. 439 

bark. The presence of bougies in the Urethra, and chronic ir- 
ritations of this canal, sometimes occasion pernicious attacks. 

7th. The rheumatic or arthritic, described by Morton, was 
characterized by pains, at first tensive, gravative, contusive; af- 
terwards, lancinating: they prevented the movement of the 
limbs. They were accompanied with heat, sometimes transient, 
and sometimes ardent, with precordial anxiety, with unquencha- 
ble thirst, with profound prostration, and with depression of the 
pulse. In this case, the gastro-enteritis was not equivocal, but 
it would be difficult to decide whether the pain of the limbs was 
sympathetic or primitive. * 

8th. We might class with pernicious intermittent fevers, the 
algid, in which the rigor and cold are excessive, the heat which 
only succeeds very slowly is inconsiderable, the thirst unquench- 
able, the tongue dry and brown: there is, likewise, syncope, and 
deglutition is embarrassed or impossible; every thing seems to 
announce the approach of death, and, consequently, a profound 
affection of the enccphalon. The excessive coldness of the sur- 
face of the body, announcing only a violent internal congestion: 
this symptom may be found in all the varieties of pernicious in- 
termittent fevers, although it is most frequently the effect of gas- 
tro-enteritis. 

If a protracted rigor seems to constitute the whole paroxysm 
in the algid fever, in the diaphoretic, on the contrary, the hot 
stage commences so promptly, there is scarcely time to recog- 
nise the cold stage, almost immediately on the establishment of 
the hot stage, an abundant sweat flows from all parts. This 
sweat is thick, clammy, often cold, sometimes it does not appear 
until the termination of the paroxysm. The pulse is frequent, 
but, weak and small, the respiration short and difficult, the mus- 
cular strength is completely prostrated, while the intellectual fa- 
culties are unimpaired. All these symptoms are not observed, 
except after those of the most intense gastric irritation; but, in 
many cases, the patient experiences the most violent pains in the 
limbs, which appear to indicate that the brain performs a very 
active part in the morbid condition, notwithstanding the integ- 
rity of the intellectual functions. The diaphoretic pernicious 
has sometimes succeeded the comatose; a fact, which shows, as 
M. Alibcrt properly remarks, that the numerous forms assumed 
by pernicious fevers, do not belong to a special and constant cha- 



440 PHYSIOLOGICAL PYRETOLOGY. 

racter, but should be considered as simple varieties.* I must re- 
mark, that the skin is not an organ of sufficient importance, and 
that the sweat is never sufficiently abundant, to warrant the opi- 
nion that the danger is due to the state of this tissue in the dia- 
phoretic fever. The sweat, like the sensation of cold, is only 
a sympathetic symptom of the intense irritation, which consti- 
tutes the disease, the seat of which should be investigated. 

The exanthematic, petechial pernicious fever, described by 
Comparetti, was only a variety of the gastro-intestinal, since it 
was characterized by pain, a sense of constriction of the sto- 
mach, and sometimes with a vomiting, accompanied by thirst. 
The eruption of red spots, after which the symptoms diminished 
in intensity, and the pulse became large and soft; and, lastly, its 
frequency was only a secondary symptom, which did not an- 
nounce in the skin a morbid condition capable of occasioning 
death. A case of this kind, reported by M. Alibert, appears to 
me to belong to cerebral pernicious fever. It is unfortunate, that 
this subject was claimed by his relations, and, therefore, could 
not be examined. 

The icteric pernicious fever of Gilbert, presents but a sin- 
gle symptom more than those of the gastro-intestinal irritation, 
which constituted the disease. 

These pernicious fevers have all been observed either with 
the tertian or double tertian type; in the latter case, the perni- 
cious paroxysms occur on alternate days; they are separated by 
paroxysms of benign intermittent, at least at the commencement: 
for, in a short time, they not only assume a well characterized 
double tertian type, but even become sub-intrant. We, how- 
ever, find in authors some cases of pernicious fever of the quar- 
tan type. 

After having briefly described the numerous varieties of per- 
nicious intermittent fevers, and having made a few remarks with 
regard to their seat and nature, it remains to consider them in 
general under these two points of view. 

Among the characteristic phenomena of these fevers, we most 
frequently observe those which announce irritation of the sto- 
mach and intestines, and, afterwards, those which indicate cere- 
bral irritation; next come the symptoms which indicate that the 

* Op. cit* p. 27. 



INTERMITTENT FEVEft. 441 

heart, the lungs, the pleura, the uterus, the kidneys, the blad- 
der, are, if not the only point, at least one of the points of de- 
parture of the morbific action; finally, the skin presents various 
sympathetic phenomena, which only merit attention when we 
view them in connexion with all the others. If gastro-entcritis 
occurs in the most pernicious intorm it tents, the irritation is al- 
ways shared by the brain in a very high degree. The case is 
the same in every pernicious fever, peripneumonic, pleuritic, 
nephritic, &c. Finally, it is probable that gastro-enteritis oc- 
curs more frequently than we should be led to think, from the 
account of authors, since they have not always exactly indicated 
the state of the tongue and abdomen. We cannot but recognise 
in most carotic pernicious fevers, primitive irritations of the en- 
cephalon. Whence I draw the conclusion, that all pernicious 
intermittent fevers are not gastro-enterites, and that there is no 
pernicious intermittent fever, whatever may be its seat, which 
may not assume the pernicious character, when the brain parti- 
cipates in it. 

All the arguments which I used in demonstrating that benign 
intermittents, are of the same nature with continued fevers, apply 
equally to pernicious intermittents. The symptoms are the same, 
but some of them are more marked. The causes are the same. 
If marsh exhalations give rise to pernicious intermittent fever 
more frequently than to malignant continued fever, this is not 
enough to establish an essential difference between them; since 
the difference arises only from the mode of action of the cause, 
and from the idiosyncrasy of the patient. 

If pathological anatomy has not yet demonstrated that benign 
intermittent is of the same nature with continued fever, it has 
not done more to demonstrate the identity of the latter with the 
pernicious intermittent. The last are common in some districts, 
and at certain seasons when they do not prove fatal, they dimi- 
nish in intensity, and pass to the chronic state, like the benign. 
As yet but a very small number of subjects has been examined 
after pernicious intermittent, because sufficient importance has 
not been attached to this kind of research. Why should these 
investigations have been pursued in pernicious fevers, when they 
were scarcely made in cases of malignant fever? However, it 
appears from some facts reported in the works of Spigel, Harvey, 
Bonet, Lancisi, Hoffman, Morgagni, Aurivill, Senac, Lieutaud, 

56 



442 PHYSIOLOGICAL PYRETOLOGY. 

and MM. Alibert, Fizeau. and Broussais,* that after intermit- 
tents which proYed fatal after a few paroxysms, there were ge- 
nerally found unequivocal traces of acute or chronic inflamma- 
tion of the stomach, intestines, and liver. The spleen almost 
always presented a softening of its texture, which is probablv the 
result of an inflammation of this organ. Sometimes traces of 
inflammation have been observed in the meninges, in the brain, 
and in the lungs. If these facts are not sufficientlv numerous to 
warrant us in deducing from them decisive conclusions, in favour 
of our opinion with regard to the nature and seat of intermittent 
fevers in general, and of pernicious fevers in particular, they 
tend to show that farther researches in pathological anatomy, as 
they are conducted at the present day, will tend to demonstrate 
the identity of the nature and seat of continued and intermittent 
fevers. We cannot too urgently solicit the physicians of those 
countries in which pernicious fevers prevail, to engage in these 
researches, and to neglect no opportunity of enriching science 
with facts which may demonstrate the truth of the new pyreto- 
logical doctrine. Death sometimes occurring in the cold stage, 
most frequently in the hot, very seldom in the sweating stage, 
often after the disease has assumed the continued form, 
different circumstances, which may vary the result of their in- 
vestigations, should be carefully noted. 

M. Bailly, profiting by his long residence at Rome, has re- 
ported a great number of autopsic examinations, of which I shall 
present a summa: 

At the termination of pernicious intermittent fevers, in which 
the encephalic symptoms predominated, such as coma, delirium, 
convulsions, he always found traces of arachnitis or encephali- 
tis, united or isolated, always traces of gastritis or enteritis, of- 
ten of splenitis: sometimes of hepatitis, peritonitis or pneumo- 
nitis, with or without traces of lesion in the cranium. / 
pernicious fevers, with a predominance of abdominal symptoms, 
traces of inflammation of the stomach and intestines were con- 
stantly found; they were very frequently accompanied by those 
of splenitis, which in certain cases were alone perceptible: in- 
flammation of the gafl bladder, in a few cases, accompanied these 

* Many of these facts are given in the u Essai sur Us Irritations Inter- 
mittentes^ of M. P. J. Montgellaz, a work which; notwithstanding some er- 
rors, deserves to be read. 



INTEHMTTTENT FEVER. 443 

phlegmasia. Gastritis seldom existed alone. In one subject 
the arachnoid, the cncophalon, the intestines, Ihc spleen, the peri- 
toneum and pericardium, all presented traces of phlegmasia. 
The spleen was frequently found ruptured. After pernicious 
algid fevers, also, traces of inflammation were detected in the cn- 
cephalon and abdominal viscera. When there had been promi- 
nent pectoral symptoms, serious lesions of the lungs were dis- 
covered; in one of the subjects there were cavities in these or- 
gans. The importance of these anatomical researches are great; 
they tend to confirm the information we possess with regard to 
continued fevers, and what we presume from analogy with re- 
gard to intermittent fevers.* 

M. Gassand has published two cases of pernicious fever, im- 
portant as it regards pathological anatomy. 

A Swiss drummer, aged twenty-seven years, of bilioso-san- 
guine temperament, had several febrile paroxysms at the com- 
mencement of August; he took brandy and pepper with a view 
to arrest them, but did not succeed. After three unsuccessful 
trials, finding himself very ill, he determined to enter the hos- 
pital on the morning of the 15th; the paroxysm commenced 
with great coldness of the whole body, accompanied with grind- 
ing of the teeth. After this stage, which continued two hours, 
the pain of the head became insupportable, the heat of the epi- 
gastrium very considerable, and the pulse assumed a remarkable 
fulness and frequency; the patient urinated with difficulty: in 
the evening the paroxysm terminated in a clammy and fetid 
sweat. The paroxysm of the 17th was more violent. Sixteen 
ounces of blood were taken and twelve grains of the sulphate of 
quinine administered in a potion. On the ISth, the paroxysm 
returned, but in a less violent manner. Abstinence, gum-water, 
sulphate of quinine twelve grains. On the 19th, no paroxysm. 
Severe regimen, six grains of the sulphate of quinine. The pa- 
tient had no fever for six days, and was allowed some mild articles 
of food, when on the 24th, he procured a bottle of wine which he 
drank in part. In the evening of the same day he was seized 
with an intense and prolonged cold stage; his teeth chattered for 
three hours; with all the covering that could be put upon him 
it was impossible to warm him. This stage having passed, a 

* E. M. Bailly, Traite Anatomico-Pathologique des Fievres Intcrmittentes 
simple et pernicieuses; Paris, 1825, in 8vo. 



444 PHYSIOLOGICAL PYRETOLOGY. 

corresponding hot stage succeeded. There was now agitation 
and delirium; the patient wished to make his escape; the at- 
tendants seized him at the moment he was climbing the gate of 
the hospital, and carried him to his bed, where he was watched 
until morning. On the 25th, the head and chest were covered with 
a cold sweat, the patient attempted to vomit, but threw up only 
a little bile. He answered no question, the dilated pupils, the 
fixed eyes, sparkling and haggard, indicated a cerebral congestion 
of the most intense character. Respiration was stertorous, the 
pulse full and very frequent. There were convulsive move- 
ments. The patient being incapable of swallowing any thing, 
a lavement of the decoction of bark, containing thirty grains of 
the sulphate of quinine, was administered. Venesection was 
practised, and at the same time the patient was placed in a warm 
bath, while cold effusions were employed to the head. At six 
o'clock in the evening there was a melioration, the patient 
spoke and took two potions containing the sulphate of quinine in 
high doses. On the 26th, a violent paroxysm: sulphate of qui- 
nine, thirty leeches to the jugulars, mustard poultices to the feet. 
On the 27th, continuation of the paroxysm of the 26th; tetanic 
rigidity of the whole body, immobility of the eyes and eye-lids, 
sonorous respiration; general sweat of a fetid odour, frequent 
and involuntary dejections; deglutition impossible. Lavement 
of bark, blisters to the limbs. At five o'clock in the evening 
remission almost imperceptible. At eleven at night exacerbation, 
intermittent rale. Death occurred on the 28th at two o'clock in 
the morning. Sanguine effusion between the two folds of the 
arachnoid, which was red, thick and a little opaque; the tissue of 
the encephalon appeared softened, its vessels, as well as those of 
the plexus choroides, were considerably injected. The lateral 
ventricles contained three or four ounces of serosity. There 
was nothing remarkable in the thorax. The stomach presented 
two patches of a deep red towards the pyloric orifice; the mucous 
membrane appeared somewhat softened; the jejunum and ilium 
especially, presented at intervals some reddish spots; the large 
intestine was in its natural state. 

A soldier, aged twenty-three years, of a nervoso-lymphatic 
temperament, entered the hospital on the 13th of September, 
1828, on the third day of a quotidian intermittent. Diverse symp- 
toms, particularly a pain deeply seated in the abdomen, diarrhoea 



INTERMITTENT FEVER. 445 

and cephalalgy, led to the belief of a gastro-enteritis, which it 
was important to combat in the first place. Rice and milk, so- 
lution of gum Arabic, mustard pediluvium; emollient fomenta- 
tions to the abdomen. These means were ineffectual, and on the 
ISth, thirty leeches were applied to the abdomen and a rigorous 
diet was prescribed. This topical blood letting produced a 
melioration of the symptoms. Yet the diarrhoea returned; the 
skin, always acrid and burning to the touch, assumed a bluish 
yellow tint, the pulse became accelerated, the prostration, which 
became more prominent, still apparently permitted the applica- 
tion of twenty leeches, on the 21st, to the umbilical region and 
anus. On the 22d, insomnolence was continual, the thirst very 
intense, and the patient uttered groans during the whole night; 
the skin was in a perspirable state, the prostration extreme, but 
there was complete apyrexia. Broth morning and evening, fric- 
tions on the limbs, with a camphorated decoction of bark and a 
gummy potion with a grain of the gummy extract of opium, of 
which the patient drank only the half, at about 9 o'clock in the 
evening. The next day, at six o'clock in the morning, the pa- 
tient was found in a comatose state, which had manifested itself 
at seven o'clock on the preceding evening. Involuntary excre- 
tions, and a copious sweat had occurred about five o'clock. The 
pulse was large and full, and exceeded ninety-two pulsations in a 
minute. The patient, when pinched, opened his eyes a little, and 
then closed them without answering or seeming to understand 
what was said to him; respiration was stertorous and deep, and 
deglutition impossible. In hopes that the paroxysm would 
terminate happily, M. Gassand prescribed a lavement of bark 
with ten grains of the sulphate of quinine, and in ten hours the 
patient recovered his speech and senses; he did not retain the 
injection, and he swallowed with less difficulty two grains of 
quinine, which were to be repeated every hour. But they were 
not administered, and in the evening M. Gassand administered 
some grains in syrup. The same symptoms as those of the pre- 
ceding night reappeared with more intensity. On the morning 
of the 24th, a comatose state more profound than the evening 
before; greater insensibility, tracheal rale. A fetid odour was 
exhaled with the insensible transpiration. The pulse was pro- 
found and very frequent. He was moribund in the afternoon, 
and death occurred at five o'clock in the evening. The body 



446 PHYSIOLOGICAL PYRETOLOGY. 

was examined five hours after. Straw-coloured tint of the skin. 
The glans and the anterior third of the penis were greenish and 
sphacelated. The external aspect of the brain, and particularly 
of the cerebellum, was of a singular bluish red; the vessels were 
extremely gorged with blood, and the arachnoid, covering the 
cerebral hemispheres, above and before, was infiltrated with an 
abundant clear serosity; this membrane being itself very red, 
owing to sanguine infiltration. The stomach presented, inter- 
nally a very slight inflammatory redness; the colour was much 
deeper over a surface which might be covered with the hollow 
of the hand. The other viscera presented nothing remark- 
able. 

M. Gaste has reported a post mortem examination, which 
tends to show that the oedema of the lungs performs a part in 
some intermittent fevers. Huct, aged twenty-two years, of fair 
complexion, lymphatic, without beard, appearing as though he 
had scarcely attained the age of puberty, entered the hospital in 
December, 1828, for a tertian fever which yielded to the sulphate 
of quinine, and reappeared a great many times after the employ- 
ment of this remedy and other febrifuge measures. The flesh of 
the patient was singularly soft, the skin of a very decided straw 
colour: his gums became inflamed and ulcerated, his breath was 
fetid, and the cellular tissue appeared to be generally infiltrated. 
Still he had a voracious appetite; he took little exercise, his apa- 
thy and indifference were extraordinary, and, as he was very 
tired of his protracted stay in the hospital, his dismission was 
granted on the I lth of March, 1829, with the request that he 
might be exempted from service for a definite period. He re- 
turned on the following June, in a state of remarkable bloating 
and infiltration, with respiration so greatly impeded that death 
seemed near. He was put upon a rigid diet, in the use of gum- 
my drinks, or of veal broth medicated with nitre. He some- 
times laid upon the back, at others times on the side, but often 
sat up in bed, being threatened with suffocation. Both sides of 
the chest sounded well on percussion; the skin was of a very 
clear and bluish yellow; the indifference of the patient was ex- 
treme; he was -discontented with every thing which was done 
for him. Finally, he died on the 20th of June, after a long ago- 
ny, during which he expectorated much serous fluid. The two 
sides of the thorax sounded well on percussion. Both lungs ad- 



INTERMITTENT FEVER. 447 

hered to the thoracic parictes; their tissue was pale, and had the 
appearance of having been macerated for a long time. From the 
incisions made into their substance, there flowed a very abun- 
dant serosity, very faintly coloured with red; the incisions, exa- 
mined attentively, presented a surface marked with small eleva- 
tions, similar to those which appear on the skin in consequence 
of cold. The heart was very large and flaccid. The pericar- 
dium contained more than a demilitre of citron-coloured serosi- 
ty. The stomach and digestive canal were pale and softened.* 

Pernicious intermittents do not differ from the benign, with 
this exception; that in the former, the principal symptoms, those 
which indicate the seat of the disease, are manifest, and are easily 
distinguished from the well characterized sympathetic symptoms 
which may accompany them. Considered in their nature, ac- 
cording to their symptoms, these fevers are then only more in- 
tense than benign intermittents; considered in their seat, they 
present more frequently an affection of the encephalon, always 
of a serious character, and this is a new proof of their analogy 
to continued fever. 

" There is no doubt," says F. Hoffman, "that the membranes 
of the spinal marrow, having the same structure, the same' na- 
ture, and the same use as those of the brain, may be affected 
with a spasmodic constriction; and that this very often occurs, 
particularly in fevers, and especially in intermittent fever; for 
the remarkable shivering, affecting the whole body, the coldness, 
the constriction of the pores and vessels of the skin, its pale- 
ness, as well as the yawning and pandiculations, are nervous af- 
fections which originate in the spinal marrow, and the pain 
which is felt about the first lumbar vertebra, at the commence- 
ment of most febrile movements, is an additional fact in support 
of this opinion." 

This opinion, which was reproduced in 1821, by M. Alard, 
was again brought forward in 1825 by M. Rayer, but with mo- 
difications which render it erroneous, by applying it exclusively 
to intermittent fever, which would thus become a cerebro-spinal 
neurosis, like epilepsy and hysteria, while continued fevers 
would be inflammations of one or more organs. It is even as- 

* Gaste, Journ. Univ. des Sc. Med. 



448 PHYSIOLOGICAL PYRETOLOGY. 

serted that intermittent differ from continued fevers, as 
?nuch as that which exists differs from that which does not 
exist* The complete absurdity of this proposition must be ob- 
vious to every one. 

M. E. M. Bailly lays it down as a principle, that in the morn- 
ing, at the moment of our rising, congestion ceases in the brain 
and establishes itself in the stomach, owing to the vertical posi- 
tion, and that then the influence of the nervous system is more 
strongly felt over the whole body; that, on the other hand, when 
we retire to bed, cerebral congestion establishes itself, the con- 
gestion of the stomach and the nervous influence cease, owing 
to the horizontal position. According to him, the intermittent 
fever is only an exaggeration of this series of organic acts. The 
principal proof which he adduces, is, that animals which are not 
subject to this alternation of the vertical and horizontal position 
are not affected with intermittent fevers in places in which they 
prevail epidemically. M. Bailly does not, however, assert that 
they are never affected, but merely that they are less frequent- 
ly affected than the human species. Candour is evinced in this 
limitation of the proposition; but the fact that the exemption of 
the lower animals is not demonstrated,! invalidates the principal 
proof of M. Bailly. This physician adds, that animals subject- 
ed to the conditions which develop intermittent fevers among 
men, suffer from continued diseases, and this fact is certainly fa- 
vourable to his opinion; but he adds, "We find in animals, after 
continued diseases, the same organic alterations as in man after 
intermittent fever/' Now, certainly, diseases which are refer- 
rible to the same causes, and which leave after them the same 
alterations, cannot but be identical in their nature. M. Bailly 

* Diet, de Med., XII. p. 390. 

f M. Lecharpentier mentions a case of intermittent fever in a horse, re- 
ported by From age. He adds, that if intermittent fever belongs particular- 
ly to the human race on account of their more exalted sensibility, and espe- 
cially on account of the organization of their skin, we yet daily observe in 
domestic quadrupeds, external local periodical affections, which are evident- 
ly the effect of the effluvia of damp and marshy places ; such is particularly 
the intermittent irritation of the ball of the eye in the monodactyles, and 
particularly in young horses at the time of dentition : this disease is in the 
commencement completely intermittent, and is then curable by bark. (Afe- 
moire sur la Periodicite, lu, en 1825, a la Society Medicate V Emulation.) 



INTERMITTENT FEVER. 449 

should, from this fact, have concluded that continued epizootic 
diseases, and intermittent epidemics, differ merely in their type. 
But he only draws the conclusion, that the same causes deter- 
mine intermittent diseases in man, and continued diseases in 
brutes; for this reason only, that the former, while awake, is in 
the vertical position, and while asleep, in a horizontal one, while 
the position of the latter is at all times horizontal. If there was 
no other difference between men and animals than that of posi- 
tion, M. Bailly might, perhaps, have discovered the cause of the 
difference of their diseases; but it remains for him to prove that 
tills is the only, or the primary difference which exists between 
the organization of the human species and the lower animals. 
It is hardly necessary to remark, that in the countries in which 
men are affected with intermittent diseases, and animals with 
continued diseases, there are some men who, from the same 
causes, contract continued diseases, notwithstanding their pos- 
tures during sleeping and waking. The theory, then, of M. 
Bailly is erroneous in its fundamental position. If he persists 
in asserting that the intermittent fever is the exaggeration of the 
modifications produced in the organism by the alternation of 
night and day, w T e shall readily agree with him, provided he will 
likewise recognise this exaggeration, of a permanent character, 
in continued fever. Finally, it must be granted, that when the 
exaggeration of a congestion leaves after it traces of inflamma- 
tion, by no means equivocal, it cannot but be an inflammation. 

Such is the result of the anatomical researches of M. Bailly; 
he has, in part, realized the desire expressed in the first edition 
of this work, and we are no longer permitted to doubt that in- 
termittent fevers are owing to inflammations, as well as conti- 
nued fevers. " In all the post mortem examinations," he re- 
marks, "which I have made of those who died of pernicious 
intermittent fevers, I have always found unequivocal traces of 
i an inflammation, which, in intensity, generally much surpassed 
i the inflammatory lesions which are observed after continued fe- 
i vers." The traces of which he speaks were not equivocal; for 
he adds, " It is already perceived that I do not speak here of 
those organic alterations which are often the subject of discus- 
sion between physicians of opposite sentiments; some being led 
: by their theory to see nothing morbid in appearances, in which 
others cannot but recognise structural derangement. I speak 

57 



450 PHYSIOLOGICAL PYRETOLOGY. 

now of disorganizations so palpable as to allow of but one opi- s 
nien. 7? * 



Treatment of Pernicious Intermittent Fevers. 

If it be improper to permit benign intermittents to pursue 
their course, it is much more so not to oppose energetically per- 
nicious intermittents, from the moment they are recognised: for 
they almost always occasion death in the second, third, fourth, 
or, at the latest, in the fifth paroxysm. I say al?nost always, 
because I am induced to believe, from some facts, that these fe- 
vers, abandoned to nature, are not always fatal, t But the ex- 
ceptions are so few in number, that we are bound to keep the 
rule alwaj-s in view. 

When, in the course of a paroxysm of intermittent fever, 
which has hitherto been benign, certain symptoms assume the 
highest degree of intensity, or unfavourable symptoms super- 
vene, which had not hitherto made their appearance; when the 
cold stage is excessively prolonged, at the same time that the 
pulse remains small and concentrated, and the features undergo 
a profound alteration, it is to be apprehended that the next at- 
tack will be pernicious, particularly if fevers of this character 
are prevalent. 

If the apyrexia is complete, the bark must be instantly admi- 
nistered, in a mean dose, without waiting for the disease to be- 
come more intense; for the first duty of the physician is to cure, 
and not to try experiments. 

If, notwithstanding the employment of the b'ark, the parox- 
ysm recurs with the phenomena of one of the pernicious fevers 
already described, there is not a moment to be lost: however 
short may be the succeeding apyrexia, we must seize this favour- 
able moment to administer the bark, not with reserve, but in £ 
full dose. 

When the physician is called in during a very short apyrexia 
which has been preceded by one or more pernicious paroxysms, 
he must instantly administer the bark in large doses, lest he 

* Traite Anatoniico-Pathologique des Fievres Intermittentes, Pari:, 
in 8vo. 

f See my Additions to the (Euvres de Medicine Pratique de PujoL Pari* 
1823. 



INTERMITTENT FEVER. 451 

should have to reproach himself with having permitted a pre- 
cious moment to pass unimproved, which perhaps will not re- 
turn. 

When the paroxysms are sub-intrant, the moment of the de- 
cline of the one, and the commencement of the other, must be 
taken for the exhibition of the bark. 

After the administration of the bark, should the paroxysms 
return, with symptoms not less alarming, or even more intense, 
we must endeavour to discover whether the ineflicacy of the 
bark is in consequence of its bad quality, or of the smallness of 
the dose. 

If, on the other hand, there is reason to suppose that the bark 
has itself exasperated or provoked the gastric irritation, if the 
tongue is dry at its centre and red on its edges, and if the epi- 
gastrium is painful during the apyrexia, the success of the next 
dose of the bark must be ensured by acidulated drinks and the 
application of leeches to the epigastrium. 

If the paroxysm returns, but without the symptoms which 
threaten a fatal termination, it is not necessary to augment the 
dose of this substance, but its employment must be continued. 

Finally, if the paroxysm does not return, the employment of 
I the bark must be continued in the same dose for several days, 
afterwards in doses gradually decreasing for one or even several 
weeks, in the same manner as though the paroxysm was ex- 
pected; that is to say, in administering the bark, that period of 
the day must be avoided on which the paroxysms formerly oc- 
curred. 

Whenever the pernicious character of intermittent fever is re- 
cognised, the bark should always be given in substance, in pure 
water, or in some distilled water, and as long as possible before 
the paroxysm which we wish to prevent; the dose should be at 
least six drams, often an ounce and a half, sometimes two ounces, 
and even more: Sims gave as much as six ounces. The half or 
i| at least the third, is to be taken at once, and the remainder in 
doses, gradually decreasing, in such a manner that the whole 
may be taken before the presumed instant of the paroxysm, 
should it occur. 

In proportion to the quantity of bark taken in a short space 
of time, will be the certainty of its effects. 



452 PHYSIOLOGICAL PYRETOLOGY. 

If the fever is a double tertian, a strong dose of bark should 
be directed against the pernicious paroxysm, and a smaller one 
against that which does not. present this character. 

It has been proposed to administer the bark in doses of one or 
two drams only, with a view to mitigate the intensity of the pa- 
roxyms, without making them cease entirely. The advantages 
of this method are very problematical, except in certain cases, 
in which the stomach retains its irritation during the apyrexia; 
for, under these circumstances, a less considerable dose of bark 
may act with almost as much energy as a stronger dose given 
under other circumstances, without, however, provoking vo- I 1 
miting. 

When the irritation of the stomach is manifest, even in the 
apyrexia, and when we are obliged to administer the bark at the 
decline, or even in the course of the paroxysm, and consequent- 
ly, when the stomach is for the most part irritated ; finally, in 
pernicious fevers, which are evidently gastric, the rejection of 
the bark is sometimes prevented, as well as the pains of the sto- 
mach, which it occasions under such circumstances, and its effi- 
cacy is ensured by associating it with opium. Far from being 
advantageous in pernicious carotic or cephalalgic fevers, this 
combination might augment the stupor or pain of the head ; might 
we not resort to it with success in pernicious, convulsive or de- 
lirious fevers? 

In cases in which deglutition has been impossible, the danger 
imminent, and the gastro-enteritis so violent, even in the apy- 
rexia, that the stomach obstinately rejected the bark, it has 
sometimes been successfully administered in a lavement con- 
taining half an ounce or an ounce of this medicine, to four ounces 
of water, or the patient has been plunged in a bath of a strong 
decoction of bark. 

Frictions with the tincture of bark have been equally advan- 
tageous in certain cases. 

When we are called in during the paroxysm of pernicious fever, 
if there have been two, and especially if there have been three 
paroxysms of the same nature, and if there be reason to appre- 
hend that it will terminate fatally, Torti advises the instant 
administration of bark, without waiting for the apyrexia, at the 
risk of its being rejected, and even at the risk of seeing it aggravate 



INTERMITTENT FEVER. 453 

the state of the patient. Others, among whom arc Senac and M. 
Alibert, think that this desperate method should not be resorted to, 
except when the stomach and intestines are free from all irritation. 

Would it be proper, whenever we are called in during the 
course of the paroxysm, to combat instantly the irritation by 
the antiphlogistic treatment, as though it were continued, and*to 
wait for the apyrexia, to administer the bark? If we only con- 
sidered the good effects of this method in many benign inter- 
mittents, we should be tempted to answer affirmatively; but if, 
under such treatment, the patient should die during the pa- 
roxysm, how severely should we reproach ourselves! 

"\\ 'hen the stomach is greatly irritated, the bark cannot be ad- 
ministered without danger: to give it under such circumstances, is 
to risk all to save all. When the stomach is not irritated, or i3 
only slightly so, the bark may be administered, and with the 
less danger; since, should symptoms of gastritis supervene, there 
will always be time to combat them: besides, there is nothing to 
prevent the employment, at the same time, of the antiphlogistic 
and derivative means, indicated by the cerebral, pulmonary, or 
other irritation which constitutes the disease. 

In the course of a pernicious paroxysm, when the symptoms 
announce a violent irritation, it would be hazardous to prescribe 
bark in any form. We must then limit ourselves to the em- 
ployment of the antiphlogistic measures employed, with a refe- 
rence to the irritated organs, revulsives applied to the skin with 
a view to hasten the termination of the paroxysm, and obtain an 
intermission. 

Are there pernicious fevers in which we should endeavour to 
fulfil preliminary indications, such, for example, as combating 
the plethora or the saburra of the primae vise, during the apy- 
rexia, before giving the bark? Torti has decidedly condemned 
this method. Many practitioners think that they should some- 
times ensure the action of the bark by the previous employment 
of blood-letting, emetics and purgatives, according to the inflam- 
matory, bilious or mucous character of the paroxysms. It is 
certain that these three measures have sometimes appeared to fa- 
vour the action of the bark; blood-letting has been advantage- 
ously practised, especially in subjects disposed to cerebral con- 
gestion, to inflammations of the viscera, and particularly of the 
lungs. This problem is certainly one of the most difficult to 



454 PHYSIOLOGICAL PYRETOLOGY. 

solve in therapeutics. To arrive at as satisfactory a solution as pos- 
sible, let it be remarked, in the first place, that there is not always 
time to employ any of these measures in the treatment of perni- 
cious fevers. When the apyrexia is short, we must take advan- 
tage of it, to prescribe the bark. When the apyrexia is not so 
short as to necessitate the administration of this medicine imme- 
diately on the termination of the paroxysm, we should not only 
bleed, if there are marked signs of sur-excitation of the heart, but 
also apply a large number of leeches to the epigastrium; when 
there are symptoms of gastric embarrassment, and still more if 
these is manifest irritation of the stomach and intestines, I re- 
commend a great number of leeches, for instance from twenty to 
forty; since, in consequence of the urgency of the case, we can- 
not permit the blood to flow for a long time, and we must be on 
our guard against the occurrence of syncope: whenever the 
leeches are full we must remove them, arrest the flow of blood, 
administer the bark, and cover the surface of the body with hot 
cloths. There is every reason to believe that this treatment 
should be preferred to emetics and purgatives, when the disease 
is owing, either entirely, or in a great measure, to gastroen- 
teritis. 

" Do not at the commencement treat as pernicious," says J. 
P. Frank, " an intermittent fever which presents a certain de- 
gree of intensity in its symptoms; do not believe that bark al- 
ways suffices for the cure of this disease; pernicious fevers have 
also their complications, which are by no means rare, sometimes 
plethora or a sanguine congestion of the head, the spinal mar- 
row, the chest or the abdomen require blood-letting, especially 
topical blood-letting by leeches and cups; sometimes, in conse- 
quence of these preliminary means, the malignity of the disease en- 
tirely disappears, and the disease assumes a more benign aspect." 

With the view to procure a longer apyrexia, and consequently 
the time necessary for the administration of the bark, Giannini 
plunged his patients into cold baths, to abridge the duration of 
the paroxysm, and hasten the development of the hot and sweat- 
ing stages. This rash practice must be rejected by every pru- 
dent physician, convinced of this truth, that although he cannot 
always cure, he should never injure. 

During the administration of the bark, the patient should avoid 
every cause of irritation, all mental emotion, and every thing 



INTERMITTENT FEVER. 455 

that might have a tendency to operate unfavourably on the brain 
or stomach. 

The regimen in the apyrexia, and the general care of the pa- 
tient during the paroxysm, should be the same as in benign in- 
termittents. 

When the bark decidedly exasperates the paroxysms, and 
prolongs them notwithstanding every thing that may be done to 
prevent this result, all that it remains in our power to do is to 
seek in derivatives of the skin, in blood-letting, in cold applica- 
tions to the head, and hot pediluvia, opium and the acids, the 
means, too often ineffectual, of arresting the progress of the dis- 
ease. 

If the fever becomes continued, we must abandon all hope of 
curing it by means of bark, and treat it according to the princi- 
ples laid down in the chapter upon continued ataxic fevers. 

The experienced practitioner, alone, can distinguish between 
sub-intrant intermittent fever, which may sometimes be success- 
fully combatted with the bark, from the intermittent fever pass- 
ing into the continued type, and in which, consequently, this 
medium must be hurtful. 

How has it escaped observation, that if the bark is generally 
injurious, or, at least, inefficacious, when administered during 
the paroxysms of intermittent fever, it must be still more im- 
proper in continued fever? I have shown that the bark being 
administered during the apyrexia, its tonic quality does not ne- 
cessarily prove that benign intermittents are not owing to an ir- 
ritation. The same remarks apply to pernicious fevers in gene- 
ral; but in the choleric, the cardialgic, and dysenteric variety, 
this application becomes more difficult, and in appearance less sa- 
tisfactory. It is objected that the bark cures intermittent fever 
even when the pain continues during the apyrexia, and when 
they are sub-intrant. This proposition is too general; the au- 
thors who have advanced it, have only mentioned those cases 
which they have successfully treated, and I cannot but remark, 
on the present occasion, that of all those who have traced the 
history of epidemic pernicious fevers, there are few who have 
confessed that death has ever been hastened or* determined by 
this febrifuge. When death occurs, it is always, according to 
them, because the bark was not administered sufficiently soon, 
or was exhibited in too feeble a dose, or was of an inferior qua- 



456 PHYSIOLOGICAL PYRETOLOGY. 

lity. They seem not even to have imagined that the violence 
of the disease could ever bid defiance to the powers of the medi- 
cine. M. Alibert has not, however, omitted to record cases in 
which the patients have died in consequence of having taken 
the bark immediately before the paroxysm. 

During his residence in Holland, M. Broussais observed that 
no intermittent fevers, accompanied with cardialgia, vomiting, 
and colic, were successfully combated by the bark. In Italy he 
witnessed the death of a patient, by no means plethoric, affected 
with a tertian fever, which, after the first dose, became quoti- 
dian, and then continued. On dissection he detected manifest 
inflammation of the lungs and stomach: the latter organ had 
been very sensible. Another subject, placed at first under the 
same circumstances, was cured by lemonade, and other relaxants 
and sedatives, which were ineffectual in the former. 

From this time M. Broussais divided patients affected with 
intermittent fever into two classes: 1st, Those who could bear 
bitters and bark; 2dly, Those whose stomachs required milder 
means. It was soon demonstrated to him that these diseases do 
not generally become mortal, except in consequence of inflam- 
mation of the viscera. Tartar emetic gave an increased degree 
of intensity to the irritation of the digestive organs; bark, wine, 
and bitters changed it into a phlogosis of a permanent and fixed 
character, and the fever became continued: it was necessary to 
resort to mucilaginous and acidulated drinks. Tartar emetic was 
the least injurious of these means, with the exception of ipeca- 
cuanha: all emetics, however, even those which consisted only 
of pure water, or of water mixed with oil, honey, or butter, 
were injurious: the vomiting, which was excited, continued 
sometimes during several days; at other times a single emetic 
caused the transition of the fever to the continued type. u Fi- 
nally," says M. Broussais, " I have seen death supervene during 
the operation of the remedy, and I have had cause to congratu- 
late myself that I witnessed this unfortunate result in the prac- 
tice of others, before I had exposed myself to a similar re- 
verse."* 

If emetics anfl bitters have produced such results in intermit- 
tent fevers, which do not appear to be pernicious, is there not 

* Histoire des Phlegraasies Chroniques, 2d edit. p. 127—136. 



INTERMITTENT FEVER. 457 

reason to believe that the bark may not always be efficacious, 
and that it may even hasten death in those cases which evident- 
ly present this character, when the digestive passages are the 
principal scat of the irritation? I do not wish to dissuade from 
the employment of bark in pernicious fevers, nor to depreciate 
the results of the experience of physicians justly celebrated; but 
only to guard young practitioners against those authors who ad- 
vise to persevere boldly in the employment of bark, even when 
it increases the intensity of these fevers. 

I think it is proper, in this place, to make some general re- 
flections with regard to the action of bark in intermittent fevers, 
whether benign or pernicious, compared with the effects of this 
medicine in continued fevers, even at the risk of falling into re- 
petitions, which perhaps may not be devoid of utility. 

If the brain is entirely free from lesion, or nearly so, in be- 
nign intermittents, it is more affected at the commencement of 
many pernicious intermittents; it is profoundly irritated in all 
cases of the latter, when they have arrived at the highest degree 
of intensity, as well as in continued fevers. It is, therefore, ne- 
cessary to endeavour principally to prevent the sympathetic af- 
fection of this organ, or to diminish, by a powerful revulsion, 
the irritation which it experiences. Such is likewise the object 
to be kept in view in continued fevers; but, in the latter, the 
visceral irritation which provokes that of the brain is continued; 
that of the brain is likewise so, whether it be premature or secon- 
dary. How can we expect to operate a salutary derivation when 
the irritation continues in all its force until it has extinguished 
the vital action? It is on this account that tj^e bark, far from 
curing continued ataxic fever, aggravates it. In ataxic intermit- 
tents, on the contrary, by seizing the instant when the abdomi- 
nal irritation has ceased, to employ the means which may pre- 
vent its return, we prevent with certainty the cerebral irritation 
which might follow; and the case is the same with an intermit- 
tent irritation of the heart, the lungs, or any other organ. If 
the encephalon alone is irritated, we likewise, in this case, at- 
tempt to operate a revulsion by anticipation, if we may so ex- 
press it, with the view of preventing the return of the irritation 
| of the organ which is most essential to the maintenance of life. 
It is time then that the successful employment of the bark in 
pernicious fevers should cease to authorize the prodigal exhibi- 

58 



458 PHYSIOLOGICAL PYRETOLOGY. 

tion of it in continued fevers, and that its success in this case 
should no longer be opposed to a theory which it confirms in- 
stead of confuting. 

The cases in which the bark is administered with advantage, 
even when the stomach is irritated in the apyrexia, and those in 
which it is successfully administered in the intermission, scarce- 
ly perceptible, which separates the paroxysms of sub-intrant in- 
termittents, or even in the course of the paroxysm when it is 
feared that it may prove fatal, should be considered as rare ex- 
ceptions; to which, principles, established upon facts much more 
numerous, should not be sacrificed; and which, moreover, it is 
sufficient to relate, to demonstrate that they are not opposed to 
these principles. 

When the stomach is still irritated in the apyrexia, it is always 
much less so than during the paroxysm, but the bark is often re- 
jected, and more frequently inefficacious, except when this or- 
gan is perfectly sound during the apyrexia. The gastric irrita- 
tion persists in the interval of the paroxysm of pernicious car- 
dial gic fever more than in any other; this is also the fever in 
which we should fear most the failure of this remedy. When 
it does not fail, the patient often suffers for years, or even during 
his whole life, from painful digestion; he is subject to derange- 
ment of the stomach from the slightest cause, having exchanged 
an acute gastritis, which threatened his life, for a chronic gastri- 
tis, the effect of the remedy which has saved his life. This 
change is certainly preferable to death, and we should not hesi- 
tate to produce it; but we should be aware that we are substi- 
tuting for an acute mortal disease, a chronic one, which will re- 
quire the employment of emollients and regimen, when all fear 
of the return of the pernicious periodical exacerbation shall have 
ceased. 

In sub-intrant fevers, the bark fails very often, or it induces 
the continued type; and, if it sometimes cures the intermittent 
fever, it more frequently gives rise to a mortal continued fever. 
What stronger proof could we have of the inflammatory nature 
of pernicious intermittent fever, and of the excitant and non- 
specific action of bark, in the latter, as well as in continued fe- 
ver? When the sub-intrant fever is apoplectic or syncopal, the 
bark succeeds more frequently than in the sub-intrant cardialgic 
or choleric, because the digestive passages are more irritated in 



INTERMITTENT FEVER. 459 

the latter: this fact forms another proof in favour of the opinion 
which I consider it my duty to advocate. A very limited num- 
ber of cases have been reported in which a cure lias been ob- 
tained, although the bark was given during the paroxysm 
through an apprehension that it might terminate fatally. 

The more nearly intermittent fever approaches the continued, 
the less efficacious is the bark, and the more does it lose its anti- 
febrile qualities to manifest only irritating qualities. Is it not 
evident, however, that the action of this medicine upon the mu- 
cous membrane of the stomach must be the same in both cases. 
However different may be the nature of these diseases, it cannot 
change that of the medicine; consequently, the difference in the 
results of the action of the remedy is derived from the diffe- 
rence of the organic state: now, since it has been demonstrated, 
that the organs are affected in intermittent fever in the same man- 
ner as in continued fever, and that the only difference between 
them is, that in the one the organic morbid condition is continued, 
while in the other it is intermittent or subject to exacerbations 
which provoke the manifestation of the sympathies, I hence 
conclude, that if the bark cures the former and not the latter, 
the reason is, that in intermittent fevers it acts upon organs 
which are sound or feebly irritated, while in continued fevers it 
acts upon organs strongly irritated. 

M. Tommasini divides intermittent fever into hypersthenic, 
resulting from excess of stimulus and determined by exciting 
causes; hyposthenic, derived from a contra-stimulus, and de- 
termined by depressing causes; and irritative, resulting from a 
disturbance of excitement, to a development of the sympathies 
of relation, in consequence of material causes which, at least 
primitively, are neither exciting nor depressing. In accordance 
with these views, he admits, 1st, that certain intermittents cease 
after some paroxysms without the aid of art, in consequence of 
the sweat; 2d, that others are arrested by the occurrence of 
some changes in the circumstances of the patient, not necessari- 
ly requiring the bark, which may be replaced by any other bit- 
ter, by unaccustomed aliment, or an unusual sensation; 3d, that 
blood-letting, diet and the contra-stimulants, among which are 
bark and bitters, cure other intermittent fevers which would not 
yield to stimulants, such as opium and wine, and which would 
even be rendered continued by the latter; these fevers may be 






460 PHYSIOLOGICAL PYRETOLOGY. 



cured without bark, and to render the bark effectual it must be 
preceded by blood-letting, and associated with contra-stimulating 
means: the bark administered alone, arrests the paroxysms, but 
they reappear, the disease not having been eradicated; these are 
the fevers which he denominates hypersthenic; 4th, that there 
are intermittents of a character diametrically opposite, in which 
blood letting, emetics, purgatives, not only do not succeed, but 
even aggravate the fever, and that they cannot be cured except 
by stimulants, such as opium and wine, or stimulants combined 
with bark; in these fevers the bark given alone would occasion 
interminable diarrhoea; these are the hy 'post henic fevers; finally, 
he thinks that certain intermittent fevers, caused by the inges- 
tion of gross aliments, cannot be arrested except by the expul- 
sion of the indigestible substance which occasions them; he has 
never seen cases of this character, but he believes in their oc- 
currence on the testimony of respectable observers: these are the 
irritative fevers. 

Bark, according to M. Tommasini, is not anti-febrile, but ra- 
ther an anti-periodic; he by no means regards it as the specific 
of intermittent fevers, since he accords the power of curing them 
to blood-letting, diet, change of habits, to all the bitters, to the 
excitants which he calls contra-stimulants, and even to those 
which he calls stimulants. 

With regard to the morbid states with which intermittent fe- 
vers are connected, he says, that among them there are some 
which do not determine any organic alteration, notwithstanding 
the repetition of the paroxysms; that others occasion by this re- 
petition local congestions, which may remain after the fever; that 
some have for their cause an analogous morbid condition which 
continues after them, and destroys the patient a long time after 
the cessation of the fever; and finally, that in others there exists 
no ancient morbid condition of the viscera to which we may attri- 
bute the fatal termination of the disease; that death is determined 
either by an excess of stimulus, as in pleuritic or soporose per- 
nicious fever; or by the last degree of depression, as in the algic, 
syncopal and sudatory pernicious fevers. 

Justice forbids us to apply the rules of criticism to these pa- 
thological and therapeutic opinions, before they have been pub- 
lished and developed by M. Tommasini. 



INTERMITTENT FETER. 461 



CHAPTER XIII. 



Of Erratic, Anomal, Partial and Masked Intermittent 

Fevers. 

The paroxysms which characterize intermittent fevers, do not 
always return at fixed epochs: they are sometimes observed to 
be separated by very short intervals, at other times by very long 
ones; in the latter case they are very seldom pernicious: this ir- 
regularity of type most generally indicates that the disease which 
then assumes the name of erratic intermittent fever, will be 
tedious and difficult of cure. The bark is here less efficacious 
than in intermittent fevers of a regular type; it is especially by a 
total change of habits, of the manner of living and of the re- 
gimen that we must seek to restore the health. In this respect 
we cannot establish other rules than those which have been 
laid down in the course of the present work, when discussing 
the diverse indications which intermittent fevers may present. 
It is especially when these fevers are irregular or erratic that they 
pass into the chronic state. 

Cases have been mentioned in which one half of the body, de- 
termined either by a horizontal or vertical section, was affected 
with a rigor, while the other half was affected with an intense 
heat; other causes have been cited, in which the rigor, the hot 
and sweating stages, pursued their courses simultaneously; we 
are assured that the cold sometimes succeeds the hot stage, {Jievres 
anomale.) Finally, the cold, the hot and the sweating stages 
sometimes manifest themselves only in a single member, the feet, 
the hands, or even on one side of the head, (local, partial or 
topical fever.) 

Without attaching too much importance to these rare cases, 
may we not say that nature presents them to us as it were to 
prove that the type merits but a secondary attention; that the 
character of the symptoms is a much more important object of 



462 PHYSIOLOGICAL PYRETOLOGY. 

attention, with a view to discover the nature of the lesion which 
they announce, and the seat of this lesion; and, that if the in- 
termission is to be taken into consideration, it is only because ex- 
perience has demonstrated that we should seize this favourable 
instant for the employment of powerful curative means? 

In a work which will always be read with profit,* Frederick 
Cassimer Medicus has collected all the cases of periodical lesions 
icithout fever, reported in the works of his cotemporaries and 
predecessors; among these, are cases of apoplexy, epilepsy, trem- 
bling, stupor, insomnolence, chorea, mania, hypochondriasis, 
hysteria, syncope, cold, heat, sweat, cutaneous eruption, icterus, 
cyano-dermia, lassitude, dropsy, paralysis, cephalalgia, vertigo, 
ophthalmia, blindness, ophthalmo-dynia, sneezing, epistaxis, 
redness of the nose, corj^za, odontalgia, alveolar hemorrhagy, 
ulcer of the gums, aphonia, laughter, buccal hemorrhage, ptya- 
lism, otalgia, deafness, loss of memory, distortion of the fea- 
tures, luxation, asthma, cough, hemoptysis, pleuro-dynia, cardi- 
algia, hiccough, haematemesis, boulimia, want of appetite, thirst, 
or want of thirst, vomiting, diarrhoea, colic, hemorrhoids, ne- 
phralgia, retention of urine, diabetes, haematuria, gonorrhoea, 
pruritus of the vulva, abortion, umbilical hemorrhage, tumefac- 
tion, with throbbing in the hepatic region, ulcer on the penis, 
on the finger, hemorrhage from the toes, 1he fingers, or the knee, 
pains in the arm, erysipelas, cramps, &c. Let it not be thought 
strange, that I should cite this long list of intermittent diseases, 
or symptoms; I do so with a view to demonstrate that there is 
scarcely any morbid phenomena, or any disease which may not 
return periodically, or any organ which does not sometimes be- 
come the seat of a periodical derangement In reading the work 
of Medicus, and the scientific annals of a more recent date, we 
are impressed with the conviction that intermittent diseases are 
much more frequent than they are generally thought. 

When we discard all preconceived opinions, and attentively 
consider the subject of periodical diseases without fever, the 
question naturally presents itself — what has caused these dis- 
eases to be considered as masked fevers, instead of being com- 
pared in the first place with continued diseases of the same na- 

* Traite des Maladies Periodiques sans Fievre, traduit de Lallemand par 
Lefebvre de Villebrune. Paris, 1790, in 12mo. 



INTERMITTENT FEVER. 463 

ture, and, in the second place, with pernicious fevers which do 
not differ from the first, except in this, that they ordinarily com- 
mence with paroxysms unattended with immediate danger, and 
are accompanied with sympathetic phenomena called febrile. 
It would then have been perceived, that benign and pernicious 
intermittent fevers do not differ from intermittent diseases with- 
out fever, except that the local irritation which constitutes the 
latter does not give rise to sympathetic phenomena in the same 
manner as the local irritation, more or less intense, more or less 
extended to several organs, and more or less shared by the sto- 
mach, which constitutes intermittent fever. 

I have just said that pernicious fevers generally commence with 
benign paroxysms, and are generally accompanied with sympa- 
thetic phenomena; because, in fact, these diseases may manifest 
themselves from the first, with the formidable train of symp- 
toms which characterize them, and sometimes be marked by no 
febrile symptom: in this case, it is difficult for the most skilful to 
determine whether there is pernicious intermittent fever, or per- 
nicous intermittent disease without fever; for it is generally ad- 
mitted, that masked fevers may be pernicious. These pretended 
fevers are themselves occasionally accompanied with some fe- 
brile symptoms, according to Medicus; a circumstance which in- 
creases the perplexity of this involved theory. 

The denomination of masked fever is so little appropriate to 
the'diseases which it designates, that even in the ancient pyre- 
tological theory, it must have appeared ridiculous to men of in- 
telligence. This denomination should then be banished from 
the medical vocabulary, or only remain as a monument of error. 

To demonstrate that periodical diseases have a certain affinity 
to paroxysmal fevers, Medicus calls the attention to the striking 
analogy of the symptoms of the first, to the symptoms of perni- 
cious fevers, the transition of these diseases into each other, 
their intermittence, the lateritious sediment of the urine observed 
in both, and the necessity of submitting both to the same curative 
means. Periodical diseases without fever are seldom cured, ex- 
cept by bark. We must then admit with Sydenham, Van- 
Swieten, Huxham, Dehaen, Stoerk, Lautter, and Medicus, that 
these diseases are of the same nature, but far from concluding 
that periodical local diseases, without febrile symptoms, are 
masked fevers, that is to say, (in the language of most physi- 



464 PHYSIOLOGICAL PYRETOLOGY. 

cians,) general diseases, disguised under the form of local dis- 
eases: we must avail ourselves of this luminous classification, as 
a strong argument in favour of the new doctrine, which consi- 
ders fevers of every type as groups of symptoms, occupying, 
apparently, the whole body, but in reality, produced by a local 
irritation. 

" Most periodical diseases," says Medicus, " have their cause 
in the abdomen, and especially in the stomach and intestinal ca- 
nal: an excessive irritability of these viscera, is the first cause of 
them; it is in the correspondence of the stomach and intestines 
with the other parts of the body, that these diseases originate; 
medical experience, and post mortem examination, have proved 
to me that it is most frequently in the abdomen, and not in the 
part affected with pain and disorder, that the visible cause of the 
disease exists. 

If Medicus had not mingled these profound views with hy- 
pothetical opinions, with regard to the influence of the bile and 
phlegm, and if his works in pathological anatomy had been 
more satisfactory, how greatly would he have accelerated the 
progress of pathological physiology! But, however he may 
have restricted his opinion with regard to the seat of these dis- 
eases, it is not correct to assert, that most of them have their 
seat in the digestive organs. How often do we see them cease, 
under the influence of direct local means. Medicus himself says, 
that Rabner cured himself of a hemicrania, from which he had 
suffered for five years, by applying leeches to the suffering part. 
If gastro-enteritis is very frequent in benign intermittent fevers, 
and even in pernicious fevers, it is much less frequent in pe- 
riodical diseases without fever: it is in this particular that the 
former differs from the latter; and it is on this account that the 
bark is almost always employed with impunity in masked fevers, 
which are not seated in the stomach. 

A complete history of intermittent irritations and inflamma- 
tions, simple, and especially complicated, acute and chronic, 
with or without sympathetic symptoms, is still a desideratum. 
M. Broussais, from whom it might have been expected, has not 
even attempted to trace that of intermittent gastritis. 



REMITTENT FEVER. 465 



CHAPTER XIV. 



Of Remittent Fever. 

Among pyretologists, some have omitted remittent fevers, 
and some have confounded all continued fevers under this name; 
others, with more propriety, have restricted the latter denomi- 
nation to continued fevers, which present exacerbations; and 
they have called those remittent fevers,* which in an uninter- 
rupted course present paroxysms analogous to those of intermit- 
tent fevers. 

According to Stoll, remittent fever should be considered as com- 
posed of two fevers, into which it should be separated as into its 
two elements: the continued and intermittent, both of which be- 
ing produced in the same individual at the same time, by the same 
or different causes, by the nature of the epidemic, by the me- 
thod of treatment, constitute the remittent. Pinel remarks with 
much sagacity, that this mode of viewing the disease is erro- 
neous, and that it may exercise a dangerous influence upon the 
treatment, by giving rise to the opinion that the intermittent 
part of the disease may be attacked directly by bark, to render 
the continued part more simple. Baumes considers remittent 
fever as a mixed kind of pyrexia, forming a shade between con- 
tinued and intermittent fever; belonging, however, more parti- 
cularly to the latter. Thus he approximates to the sentiment of 
Stoll, while he endeavours to differ widely from him. Baumes 
thinks that we should consider as remittent fevers even those, 
the return of which, nearly periodical, are not, or are no longer 
announced by a rigor: he adds, and this opinion is remarkable, 
that between the remittent and intermittent fever the difference 
is only in degree. Finally, the same author thinks, with Laut- 

* These fevers have been variously designated by the names of paroxysmal, 
sub-continued, exacerbantes, proportionnees* 

59 



466 PHYSIOLOGICAL PYRETOLOGY. 

ter, that the exacerbation or paroxysm, and the remission should 
be spontaneous, to constitute remittent fever. However scholas- 
tic this idea may appear, it is. nevertheless founded upon obser- 
vation. All continued fevers would be remittent, if we desig- 
nated thus all cases in which there supervenes an exacerbation, 
or even a paroxysm, because the patient has been exposed to cold; 
or a remission, because he has been bled. 

Continued fever becomes remittent, when we observe the fol- 
lowing symptoms: 

Before the paroxysm, heavy, unrefreshing, or interrupted 
sleep, mouth foul on awaking, pain, or simply weight of the 
head, eyes heavy, or red, and dejected, sadness, disgust, disa- 
greeable sense of heat, felt principally in the palms of the hands, 
and soles of the feet. 

In the paroxysm, malaise, sense of great lassitude, of tension 
in the muscles, of rigidity in the articulations, a movement of ex- 
tension in some, and of tension in others, a more or less irresisti- 
ble inclination to sleep, paleness and lividity of the nails, coldness 
of the end of the nose, and tips of the fingers, difficult respiration, 
painful inspiration, frequent pandiculation and yawning, sensa- 
tion of cold on the skin at intervals, obtuse pains in the limbs, 
universal trembling, chattering of the teeth, paleness of the face 
and lips, somnolence, and sometimes slight delirium, small dry 
cough, considerable thirst, with dry, clammy, or bitter mouth, 
frequent desire to urinate, urine scanty and pale, sometimes tur- 
bid, pulse small, frequent, wiry, occasionally convulsive move- 
ments, great anxiety: when the patient is very irritable, impa- 
tience. This period declines insensibly: the rigors, trembling, 
and convulsive movements by degrees become less frequent; the 
pulse is alternately developed and concentrated; slight flushes of 
heat interrupt the sense of chilliness; copious vomiting super- 
venes: sometimes there is a kind of syncope, a mild and general 
heat succeeds, and the pulse becomes decidedly accelerated; the 
nausea and vomiting generally cease, and the urine flows; some- 
times, though not so frequently, it is red and hot: the patient is 
hot and uncovers himself, the face is red, the breath is hot, the 
eyes brilliant, the skin dry and hot, the thirst excessive, the res- 
piration less embarrassed, but more frequent, the pulse full and 
strong, equal, or frequent and quick, the pulsations of the tem- 
poral and carotid arteries are sensibly felt, and sometimes very 



REMITTENT FEVER. 467 

marked delirium supervenes; sometimes pimples make their 
appearance, or a red eruption resembling urticaria; pains of the 
back, loins, joints, and head; all the symptoms increase in in- 
tensity during a certain time, and continue at the highest state 
of intensity for a longer or shorter period; then the alternation 
or diminution, and return to a state of violence begins to occur; 
afterwards the symptoms decline, the skin is by turns dry, 
burning, temperate, and moist; it then becomes soft and per- 
spirable; the urine flows abundantly; it is of a citron colour, 
thick, sedimentous, sometimes depositing a lateritious sediment, 
the perspiration is re-established; sweats or bilious stools, and 
sometimes both, terminate the paroxysm. 

After the paroxysm, the patient experiences a melioration of 
his condition; he sometimes even believes that the disease has 
ceased: with the exception of a painful sense of fatigue, of bit- , 
terness of the mouth, fetor of the breath, some remaining heat of 
the skin, and a disposition to rigor, we observe all the symptoms 
which existed before the commencement of the paroxysm. 

Such is, according to Baumes, the description of an intense 
and well characterized remittent fever; it is the same as that of 
intermittent fever. Consequently, the remarks which have been 
made with regard to the latter are applicable, in this respect, to 
the remittent fever. But Baumes has not confined himself to 
the description of benign intermittent fever; he has pointed out 
the symptoms of that which presents a character of malignity; 
he has described the pernicious remittent fever, which has been 
passed over in silence by most of our cotemporaries. 

"From the commencement of this fever," he remarks, "the 
pulse is soft, w r eak, small and profound, often unequal; the prin- 
cipal symptoms are nausea, obstinate vomitings, cardialgia, anx- 
iety; serous, bilious, very liquid diarrhoea; swelling of the face, 
deafness, somnolence, deep pains, delirium rather tranquil than 
furious, lethargic affection, difficulty of respiration, meteorism of 
the abdomen, uncertainty of the movements. In some epide- 
mics, only, the pulse is of considerable violence. Before the 
paroxysm commences the patients are depressed, suffer from ver- 
tigo, and are threatened with fainting. Great coldness suddenly 
supervenes, with pains which appear to come from the spinal 
marrow; the pulse is deep, and its vibrations, which are scarcely 
sensible, are confused; the patient, motionless and cold, experi- 



468 PHYSIOLOGICAL PYRETOLOGT. 

ences weight of the epigastrium, and vomits green bile. After- 
wards an acrid heat is developed, and the pulse rises slowly; 
then, even when it rises, it is more weak, soft and small than in 
ordinary cases, and it retains its irregularity; the skin is rough, 
dry and hot, and its heat of a more biting (mordicante) charac- 
ter than in continued fever, and is not covered with sweat until 
after the lapse of ten, twelve or fifteen hours. After the parox- 
ysm the fatigue is extreme; there remains an impression of heat 
in the mouth and interior of the body; the pulse is still similar 
to that of the access, or it is less frequent than the natural pulse; 
there is a discharge by the mouth and anus of serous, bilious, 
green and fetid matters. The following paroxysms occur at 
shorter intervals, and manifest greater violence; the morbid phe- 
nomena increase in intensity, and after the fourth, fifth or sixth 
paroxysm, the remission is scarcely perceptible; the disease has 
assumed the continued form, and has acquired an extreme vio- 
lence; the urine is limpid: the life of the patient is in the great- 
est danger. 

Baumes has sagaciously remarked that all these symptoms are 
far from being constant in their occurrence either in the benign 
or in the pernicious remittent fever; and that sometimes the re- 
mission in consequence of the calm of the circulation may be 
mistaken for an intermission, if the state of the pulse be alone 
regarded; but when all the circumstances of the patient are con- 
sidered, it is not difficult to distinguish the remission from the 
intermission, except in certain cases, in which the disease is equi- 
vocal; for nature sports with all our classifications without ex- 
ception. Baumes thinks, besides, without appearance of reason, 
that the number of pernicious remittents is greater than that of 
pernicious intermittents; but, to pronounce on this subject, it is 
necessary to be in possession of a series of well observed facts 
and nosological tables, kept with care in all the countries in 
which pernicious fevers prevail. 

There are, according to Baumes, three sorts of remittent fe- 
vers. The first comprehends all fevers the paroxysms of which 
commence with a rigor; the second comprehends all those the ex- 
acerbations of which commence either by coldness of the whole 
body, or only by a coldness of the extremities, or of the nose, 
or by a dry and more or less sharp cough ; the third compre- 
hends all those, the paroxysms of which do not exhibit in their 






REMITTENT FEVER. 469 

commencement either rigor or partial coldness, and are remark- 
| able only for the exacerbation of the fever and the augmentation 
; of the acrid heat, and other febrile phenomena, which decrease 
i after having risen to their highest degree of intensity. 

The first or the first and second paroxysms of remittent fever, 
of the two last kinds, commence with a rigor which is generally 
considerable, and all the paroxysms terminate by sweating and 
the discharge of sedimentous urine. Fevers of the first kind 
more nearly resemble intermittent than continued fever, but the 
reverse is the case with those of the third kind. As it respects 
danger, Baumes distinguishes remittent into benign, less benign, 
when the paroxysm is attended with delirium, oppression, a dis- 
tressing cough, moderate meteorism ; and grave, when there su- 
pervene in the exacerbations, faintness, syncope, or a phrenitic 
delirium, or a soporose or apoplectic affection; convulsive move- 
ments, a considerable or painful meteorism; symptoms of pleu- 
risy, of pneumonia, hepatitis, dysentery, of an inflammation of 
the abdomen, and when the pulse becomes soft, small, and une- 
qual. With regard to the inflammatory symptoms, they are the 
effect of the fever, if they are subordinate to it, that is to say, if 
the fever has manifested itself without them, if they have not 
appeared until the second or third paroxysm, or even at a period 
somewhat earlier, if they have no traces or only very obscure 
traces in the remission. If, on the contrary, the inflammatory 
symptoms have appeared before the fever, or at the same time 
with it, if they continue with rigor during the remission, the fe- 
ver is subordinate to the local inflammation, or it pursues its 
course simultaneously with it. In consequence of this distinc- 
tion, Baumes divides remittent fevers into encephalic, soporose, 
hepatic, pleuritic, dysenteric; and he reports the history of a 
pneumonic remittent fever, which he observed during the au- 
tumn of 1782. 

It is evident that this exact account of the ancient opinions 
with regard to remittent fevers, so ably given by Baumes, pre- 
sents the history not of an acute febrile remittent disease, but of 
the remittance of acute diseases of a febrile character; that is to 
say, attended with disturbance of the circulation. In this de- 
scription we find enumerated all the phenomena observed in con- 
tinued and intermittent fevers, with the same variety of inten- 
sity and a new combination. We have a mixture of the symp- 



470 PHYSIOLOGICAL PYRETOLOGY. 

toms of acute irritation and disorganization of the brain and its 
membranes, of the stomach, the intestines, the peritoneum, the 
lungs, the pleura, the heart, and, in a word, of all the viscera. 
These affections give rise to remittent as well as to continued 
and intermittent fevers ; they are irritations and inflammations 
occupying one or more organs, and appearing to the eyes of a 
superficial observer to invade the whole organism, some of the 
phenomena of which are permanent and others periodic; so that 
the disease might be said to recommence more or less frequent- 
ly without having, however, ceased for a single instant. It may 
be readily perceived that such a state must always be very seri- 
ous, provided it is at all prolonged. 

As remittent fevers have been considered as composed of a 
continued and intermittent fever, they have always been regard- 
ed as resulting from the causes which produce both, but espe- 
cially from those which give rise to the latter. As these causes 
have already been mentioned, they shall not be repeated here. 
We shall only mention, as meriting the attention of observers, 
the opinion of Alexander, of Chiannini, and of Ramel, who think 
that fogs and the extreme atmospheric humidity of marshy coun- 
tries produce periodical fevers. Without denying, with them, 
the existence of marsh miasmata, which, however, is not well 
demonstrated, it is certain that this humidity, especially in con- 
sequence of the heat which is joined with it, must have a very 
considerable effect in the production of diseases which affect the 
intermittent or remittent type. Baumes thinks that humidity 
is not sufficient to produce this effect, and that it can only give 
rise to simple cachexy and hemorrhage; but he forgets that, be- 
sides this cause, there exist all those which are capable of irritating 
the viscera, and that intermittence and remittence are perhaps only 
derived from the state of the skin, which is incessantly macerated, 
so to speak, in a humid and hot air: we know that a diminution of 
action in one organ, predisposes the others to active congestions, 
to an afflux of blood. All this is in favour of the opinion of M. 
Roche, with regard to the cause of intermittence. 

M. Robert Thomas says, that in post mortem examination of 
those who die of remittent fever, we generally find congestions 
of blood in the liver, inflammations of the digestive passages, 
and alterations of the brain. 

I have opened, or seen opened, in a practice of forty-five 



REMITTENT FEVER. 471 

years, many persons who had died of fevers, and have always 
observed congestions in the viscera which are naturally san- 
guine, collections of bile or mucosity in the apparatus of biliary 
and intestinal organs. These disorders were generally accom- 
panied with sanguine, serous or mixed sanguinolent, or sanious 
effusions; the membranous organs were often thickened; the pa- 
renchymatous organs were either renitent or soft, filled with 
granulations which were likewise found in the affected mem- 
branes: finally, the internal surfaces sometimes tearing with con- 
siderable facility presented either the net-work of vessels which 
entered into their formation strongly distended, and as it were 
injected or large red spots, occasionally blackish points or true 
eschars. He adds, that the disorders were principally observed 
in the head when the air had been cold and dry; in the abdomen 
when it had been dry and hot; in the chest when there had been 
rapid alternations of heat and cold, of dry and damp weather, 
with a predominance of dryness. 

Baumes, then, acknowledges that the same morbid traces are 
detected after remittent and continued fevers. M. Bailly has 
recently proved at Rome, that the traces are also the same after 
pernicious intermittents; consequently, the identity of the seat 
and nature of these three orders of fever is demonstrated. 

Remittent fevers are more frequently quotidian than the in- 
termittents; they are less frequently tertian; they are sometimes 
double tertian, and seldom quartan: according to Sauvages, Co- 
lombier and Baumes, every sub-intrant fever is remittent; it 
is certainly difficult, in such a case, to determine whether the 
disease is remittent or intermittent. Baumes thinks that the 
double quotidian and most other double intermittents, should be 
considered as remittents. Such are the difficulties and subtleties 
in which we are involved, when we attach too much importance 
to the type of diseases, and when we make special and distant 
affections of diseases, the types of which differ, although the 
phenomena are the same in both. 

Baumes admits remittent fevers, with inflammatory, putrid or 
nervous tendencies, with a catarrhal, bilious or gastric state. Pi- 
nel questions the existence of an inflammatory remittent fever, 
admitted by Macbridc, but he admits a gastric remittent fever. 

The diseases of this kind which Pinel observed affected old 
men; they occurred in the Salpetriere, and they appeared towards 



472 PHYSIOLOGICAL PYRETOLOGY. 

the decline of autumn; they were produced by all the causes, 
physical and moral, of fevers: like gastric continued fevers-, they 
were characterized by supra-orbitar headache, a mucous or yel- 
lowish covering of the tongue, a sense of bitterness in the mouth, 
with pain of the epigastrium. Who can mistake here the symp- 
toms of gastro-enteritis, especially if we add to them, as he does 
in several cases, diarrhoea or constipation, of a more or less ob- 
stinate character, and continued vomiting. Even when skilful- 
ly treated, they prolonged themselves, he remarked, even to 
the fortieth or forty-second day, and sometimes terminated to- 
wards the end of the second week. 

Pinel described, likewise, a mucous remittent fever, charac- 
terized by the frequent return of abdominal pains, a painful dis- 
charge of urine, a sort of salivation, a mucous tongue, horripila- 
tions in the night, augmented heat often interrupted with rigors, 
apthae, paroxysms which, towards the decline of the disease, de- 
generate into simple exacerbations. The duration of diseases 
of this kind, is not shorter than that of gastric remittent fevers. 
He, with reason, refers the hemitritcea of the ancients, and. of 
Spigel, to the mucous remittent fever. He admits incidentally, 
that the adynamic fever maybe remittent, and considers as such, 
many pretended cases of adynamic intermittent fever. We 
have frequently observed gastro-enterites with symptoms called 
adynamic, and well characterized exacerbations, preceded by a 
cold stage of little intensity and followed by sweating which was 
neither very copious nor very hot. Pinel has classed with atax- 
ic fevers, pernicious remittent fevers, called sub-intrant, because 
their paroxysms encroach upon each other. These diseases are 
more dangerous than pernicious intermittents; it is much to be 
desired that some physician having charge of a hospital in a 
country in which these diseases prevail, should produce an ana- 
tomical and clinical history of these diseases, equally elaborate 
with that of Torti, with regard to their symptoms and thera- 
peutics. 

We shall dwell no longer on the causes, symptoms, nature 
and seat of remittent fevers, and we request the reader to apply 
to them the remarks which have been made with regard to the 
nature and seat of continued and intermittent fevers. We should 
only add, that if intermittent fevers sometimes become remittent, 
the latter frequently become continued. We have very lately 



I; 



REMITTENT FEVER. 473 

observed this scries of transitions in a female, who presented all 
the phenomena of a hepatitis, at first intermittent, and succes- 

• sively remittent, continued, and again intermittent. 

Remittent fevers of little intensity, are only dangerous in con- 
sequence of their tendency to provoke profound and apyrctic al- 
terations in the viscera; they seldom threaten the life of the pa- 

1 tient; they often resist with obstinacy every kind of treatment, 
and do not cease until after the lapse of a month or six weeks. 
Intense remittent fevers are, on the contrary, very dangerous; 
they threaten immediately the life of the patient, and often prove 
fatal in a few paroxysms. 

Blood-letting sometimes, emetics and purgatives often, bark 

i always: such is the treatment generally recommended against 
well characterized remittents by authors who have adopted, 
without modification, the opinions of the ancients. We have 
seen above, that Pinel combated the opinion of Stoll, because it 
led to the prodigal employment of bark in remittent fevers: Pinel 

I recommends the same treatment in these fevers as in the conti- 

i nued type; he, however, advises, in consequence of their great 
duration, to sustain the strength of the patient with wine and wa- 
ter, rice and barley-water, cooked fruits, beer mixed with an 
equal quantity of water; it is not until the decline that he re- 
commends tonics, wine of wormwood, extract of juniper-berry 
and more substantial nourishment. With regard to ataxic re- 
mittents, which are almost always tertian or double tertian, he 
recommends, after the example of Torti, the employment of 
bark as in ataxic intermittents. 

Remittent fever may, in our opinion, be with advantage dis- 
tinguished into two species: the first species comprehends those 
cases, which are attended with no symptoms of imminent dan- 
ger and the other comprehends those in which the paroxysms 

J approach each other, and become more and more alarming, in 
consequence of the lesion of the nervous system, and especially 
of the encephalon which characterizes them. To the first, we 

! assign the name of benign, and to the second, that of pernicious, 
in the same manner as in intermittent fevers, and without at- 
taching any particular importance to these denominations. 

Benign remittent fevers should, according to Pinel, be treated 
in the same manner as analogous continued fevers; but this au- 
thor did not perceive that the existence of paroxysms required 

60 



474 PHYSIOLOGICAL PYRETOLOGY. 

particular attention, and that it was important to abridge the 
long duration of these diseases, with a view to prevent the ob- 
scure and chronic phlegmasia^, which frequently follow them. 
Stoll asserts with reason, that we should pay more regard to the 
continued symptoms, than to those of the paroxysms, except 
when the latter present the pernicious character; that remittent 
fevers should not all be treated according to the same method; 
that blood-letting may be useful, while, on the other hand, the 
bark converts a remittent fever into a continued, a grave or ar- 
dent fever, when the paroxysms do not announce any imminent 
danger. These remarks should be understood as relating only 
to the impropriety of a treatment adopted, with the view of put- 
ting an end to the paroxysms by bark alone; Stoll may with ad- 
vantage be opposed to Torti and Baumes. But we must not 
hence conclude that we should renounce every remedy but bark 
in the course of the paroxysm, with the view of abridging the 
latter, rendering them less intense, and preparing the return of 
the disease to the continued type. Experience has demonstrated 
to u$, since the first publication of this work, that we must com- 
bat with energv the paroxysms themselves, in the same manner 
as we should act in case of a complication supervening in a con- 
tinued disease. There are, then, two sources of indications in 
the present diseases — the remission and the paroxysm. 

During the remission we must act precisely in the same man- 
ner as though the disease were continued, or at most, had only 
simple exacerbations of little intensity; it is consequently unne- 
cessary' to repeat here what we have said: and what we shall say 
of the treatment of continued fevers. But we should here re- 
mark, that it is never proper in benign remittent fevers, to ad- 
minister the bark during the remission, unless we have pre- 
viously, by the employment of emollients and the local abstrac- 
tion of blood, converted the remission into a true intermission, 
an event of frequent occurrence, when we employ the antiphlo- 
gistic treatment. Otherwise, we incur the danger of converting 
a benign intermittent fever into a grave continued fever. When 
it has been judged expedient to abstract a large quantity of blood 
during the paroxysm, it is proper to permit the patient to enjoy 
complete repose during the succeeding remission, and only to 
employ emollients internally, with sometimes an evacuant lave- 
ment, or a rubefacient applied to the skin, if the circulation is 
not perceptibly accelerated. 



REMITTENT FEVER. 475 

It was in the remission that emetics and purgatives were for- 
merly administered; they may be advantageously used when the 
remission has been replaced by an intermission: in this case, they 
are sometimes useful in persons of little irritability; this, at least, 
may be said of purgatives, for emetics more frequently provoke 
than cure remittent fevers. This fact is very important, and 
should not be forgotten. 

During the paroxysm we should employ the same treatment 
as in a continued fever which had attained its highest degree of 
intensity. This principle has not hitherto been laid down with 
sufficient distinctness; but there is an important distinction to be 
made, viz. that in the cold stage we must act as though we were 
treating a disease at its commencement, and it is only in the hot 
stage that we must resort to the active treatment which we have 
recommended; whilst, in the sweating stage, the only thing ne- 
cessary is to prevent the patient uncovering himself incautious- 
ly, becoming cold, eating; in one word, prevent his deranging 
in any manner the movement from the centre to the circumfe- 
rence, which should be favoured by some agreeable warm drink, 
given in very small doses. 

During the intensity of the paroxysm we must study which 
is the organ most affected, the lesion of which is most hazardous 
to the patient, or, at least, presents the most prominent patholo- 
gical condition; we must then resort to the most natural means, 
which are clearly indicated in gastritis, enteritis, hepatitis, arach- 
nitis; in one word, against the irritation which gives rise to the 
symptoms of the paroxysm. 

Pernicious remittent fevers should be treated according to the 
same principles, with this difference, that when the antiphlogistic 
means have been employed with promptness and decision, in the 
hot stage of the paroxysm, the bark should be given in the re- 
mission, if the danger is urgent, the life of the patient threat- 
ened, if there have been already two, three, much more if there 
have been four pernicious paroxysms. This is the most difficult 
case in practical medicine. This method succeeds very well 
when the irritation which constitutes the paroxysm exists only 
in the encephalon. When it is recent, and when the digestive 
passages are but slightly, or not at all irritated; perhaps, like- 
wise, when the irritation is seated any where else than in the di- 
gestive passages, though it may occupy an abdominal organ. It 



476 PHTSIOLOGICAL PYRETOI.OGT. 

has been likewise observed to succeed in cases in which the gas- 
troenteritis was stA manifest during the remission. The folly 
which does not comprehend, and the improbity which misrepre- 
sents, have accused us of denying cases of this kind. A feet is 
more precious in our eyes than the most laboured theory; and, 
if we attach importance to theory, it is only on account of its 
connexion with practice. We repeat, that it is not more asto- 
nishing to observe the cure of gastro-enteritis, in consequence of 
the application of bark to the stomach, than to see an ophthal- 
mia cured by the application of a collyrium of alum, an erysi- 
pelas by the application of a blister, a boil by the application of 
citric acid, a urethritis by the injection of sulphate of zinc; but 
we have never said that bark acted as a blister; we know that 
the bark does not cause the removal of the epidermis, especial- 
/.ere it does not exist; we know that this substance is not 
an excitant — an evacuant phlegmasick — but rather a tonic, a de- 
siccative phlegmasick, a tannant, and that one or another of these 
effects predominate according to the state of the organ and the 
individual predisposition. Nothing is more unworthy of a man 
of sense and information than to attribute to a single medicine 
the absolute quality of a febrifuge, an anti-periodic, when it has 
been demonstrated that this substance, in cases in which it ap- 
pears to be most decidedly indicated, sometimes increases the 
fever, and that by giving it during convalescence, in the days 
corresponding to those of the paroxysms, it reproduces them, 
as Baumes has said, and as we ourselves have remarked. 

However imposing may be the authority of Torti, there is cer- 
tainly danger in incautiously prescribing the bark in pernicious 
remittents, because this medicine often aggravates benign inter- 
mi ttents, which yet present an apyrexia of sufficient duration, 
and still more sub-intrant benign intermittents. Ramazzini has 
observed epidemic intermittent fevers in which the bark was 
more dangerous than useful, doubtless because the digestive or- 
gans continued irritated in the apyrexia: much more, conse- 
quently, may this medicine be injurious when it is adrninistered 
without preparation in remittent fevers. We formerly said that 
these fevers often resisted, or yielded only temporarily to blood- 
letting; but this is in consequence of our not having recourse to 
this measv: pt in the remission: since we have practised 

it, at the instant when the paroxysm is in its highest degree of 



REMITTENT FEVER. 477 

intensity, we either abridge it considerably, and the following 
remission is frequently a true intermission, which permits us to 
administer the bark, or the paroxysm diminishes only in inten- 
sity, and the patient has now only a continued fever, which we 
must combat by the application of leeches at the time of the sim- 
ple exacerbations, which take the place of the paroxysms. 

The existence of remittent fevers, forming so natural a transi- 
tion from continued to intermittent fevers, presents an insur- 
mountable obstacle to the adoption of any theory in which in- 
termittent fevers are considered as being of a different nature 
from continued fevers: otherwise we must suppose that remit- 
tent fevers are of two different natures at one time, or of two 
alternating natures. 



478 PHYSIOLOGICAL PYRETOLOGY, 



CHAPTER XV. 



Of Chronic Fevers. 

Fevers, whatever be their type, often prolong themselves 
during months, and even years, but not always with the degree 
of intensity which they present when acute. Before passing to 
the chronic state, continued fevers seem to cease altogether, or 
else some of their symptoms persist after the immediate danger 
has passed. Intermittents, in passing to this state, do not always 
become on this account less intense; but frequently the parox- 
ysms do not appear at periods equally definite, as in the com- 
mencement of the disease. A continued acute fever is some- 
times followed by a chronic intermittent fever, which towards 
the fatal termination generally resumes the continued type. 

The name of Splanchnic has been given to chronic inter- 
mittent fevers which are accompanied, or rather which are oc- 
casioned, by a manifest lesion of one of the abdominal viscera. 

When chronic fevers have continued for a long time, and 
sometimes even in the first weeks of their existence, whatever 
be their type, a remarkable diminution of strength is observed, 
and an emaciation, which generally proceeds with rapidity: these i 
fevers are then called hectic. 

Debility and marasmus are more rapidly established in conti- 
nued chronic fevers, which more readily assume the name of 
hectic fevers; it is different in chronic intermittent fevers, the 
paroxysms of which, separated by intervals more or less conside- 
rable, allow, at least for some months, a renewal of the strength 
and nutritive materials. 

The time during which the strength remains unimpaired, and 
the body free from emaciation, in chronic continued fevers, has 
been but little investigated. It was by fixing his attention upon 
this important subject of observation, that M. Broussais recog- 



CHRONIC FEVERS. 479 

nised the distinctive characters of several phlegmasia?, of which 
he has given the history in his important work upon these in- 
flammations. I cannot do hotter than to refer the reader to this 
immortal production, which is one of those books which will 
survive through all aires. We are indebted to the same author 
for a history of hectic* fever, superior to the work of Truka 
upon this disease. 

M. Broussais defines hectic fever — a continued slow fever, of 
a long and indeterminate duration, with consumption of the 
forces, and emaciation; and, to complete the symptoms of this 
morbid state, he adds the following characters: "Febrile move- 
ment, slow and continued, with exacerbations in the evening, 
most frequently after eating; sometimes of an irregular charac- 
ter, during which the patient experiences a sense of heat in the 
palms of the hands and soles of the feet, and after which they 
have abundant sweats, which debilitate them greatly; emacia- 
tion, more or less rapid in proportion to the activity of the fe- 
ver, and the abundance of the sweats and diarrhoea." He ad- 
mits three degrees or periods of this fever: in the first it is 
obscure, irregular, and the functions but little altered; in the 
second, the pulse, which is always small, quick, and frequent, 
becomes accelerated in the exacerbations, during which heat of 
I the hands and feet manifests itself, and copious and debilitating 
sweats occur; the emaciation is then rapid: finally, in the third, 
all the symptoms are very intense, and the emaciation is carried 
to the degree of marasmus; the patient resembles a skeleton, co- 
vered with a dry and clay-coloured skin. 

This author distinguishes hectic fevers, derived from a le- 
sion of the action of a single system, from those which depend 
J upon a lesion of action in several systems. This division be- 
I ing founded upon an incomplete analysis of the phenomena and 
• causes of the disease, an analysis, the defective character of 
' which M. Broussais has himself recognised, I shall not dwell 
upon it. But among the different species of hectic fever which 
he admitted, when he wrote his Dissertation on these diseases, 
there are several which are deserving of all our attention: these 

* Researches upon Hectic Fever, considered as dependent upon a lesion: 
of action of the different systems, without organic disease. Paris, 1803 r 
in 8vo. 



480 PHYSIOLOGICAL PYRETOLOGY. 

are the gastric, the pectoral, the genital, the hemorrhagic, the 
cutaneous, and the moral. 

To the first he assigns the following distinctive characters: 
anorexia, dryness of the mouth, copious secretion of saliva, dif- 
ficult digestion, accompanied by a sense of weight, eructation, 
vomiting, cardialgia, precordial uneasiness; sometimes, he re- 
marks, the appetite continues, or is increased, but the digestion 
is always laborious. In infants who have just been weaned 
there is also lienteria, and sometimes boulimia. To these symp- 
toms are sometimes added, bitterness, and a clammy state of the 
mouth, a yellowish white or mucous coating of the tongue: sen- 
sibility of the epigastrium, and supra-orbitar headache. When 
the disease has been exasperated by improper food, by high sea- 
soning and cordials, the cardialgia and uneasiness are more dis- 
tressing, and there is a sense of heat at the epigastrium. Some- 
times food of the mildest character occasions acute pains, and is 
often rejected by the stomach. Finally, paleness, dilatation of 
the pupil, itchiness of the nostrils, acidity of the breath, saliva- 
tion, pains in the abdomen, mucous diarrhoea, and still more the 
discharge of worms, indicate the presence of these animals in 
the digestive apparatus. 

These symptoms do not permit us, at the present day, to 
mistake a chronic gastritis with habitual acceleration of the 
pulse, and a more or less regular exacerbation of this accelera- 
tion. We should, I think, attribute to the same organic cause 
hectic fevers, arising from prolonged lactation, since the result 
of this kind of excess is an increase of the digestive action ; and, 
finally, an inflammation of the stomach. 

The pectoral hectic fever has the following characteristic 
symptoms: 1st, Sometimes an acute pain in the larynx, a con- 
vulsive cough, with redness of the face, fear of sudden suffocation, 
sometimes ceasing suddenly; the trachea is then the seat of chro- 
nic irritation, the proximate cause of this fever; 2dly, Sometimes 
a strong and frequent cough, an expectoration often purulent 
and abundant, dyspnoea, a general pain of the chest, a sense of 
uneasiness and weight under the sternum: the bronchial mucous 
membrane is then the seat of the irritation which provokes the 
fever; 3dly, Sometimes we observe signs of the chronic phleg- 
masia of the pulmonary parenchyma, or of the lungs, upon 
which it is not necessary to dwell in this work. Thus the pec- 



CHRONIC FEVERS. 481 

toral hectic fever depends upon a laryngitis, a bronchitis, a pe- 
ripneumonia, or", finally, a chronic pleurisy. The signs of gas- 
tritis are frequently, though not always, associated with these 
inflammations. 

The characters of the genital hectic, are a discharge of a mu- 
cous, whitish, yellowish, or greenish matter, more or less acrid 
and fetid, a sense of scalding and pruritus in the vagina and ure- 
thra. Anorexia, dyspepsia, pains at the epigastrium, the loins, 
and the thighs, generally accompany this discharge, and indicate 
that chronic inflammation of the stomach generally accompanies 
that of the genital mucous membrane. We should class with 
this hectic fever, that which arises from chronic inflammation of 
the bladder, known under the name of catarrh of this organ. 

Hectic, in consequence of excessive hemorrhage, should not 
be attributed to weakness, the result of loss of blood. Every 
hemorrhage being the result of an irritation of the bronchial or 
gastric mucous membrane, or of some other part, the fever re- 
sults from the irritation which is the seat of the hemorrhage. 
Hemorrhage from wounds, and considerable losses of blood, 
from whatever cause, do not occasion fever except indirectly, 
and only when the action of the gastric passages repairs by a 
more rapid digestive action, the loss of materials sustained by 
the economy. Hectic fevers succeeding the disappearance or 
suppression of periodic or habitual hemorrhages, are the result 
of a supplementary irritation, which establishes itself either in 
the digestive passages, the lungs, the genital apparatus, and per- 
haps in other parts, such as the liver. The same principle ap- 
plies to hectic arising from suppression of the perspiration. The 
fever in which excessively copious perspiration occurs, does not, 
on this account, differ from the others; for it is not a single ad- 
ditional symptom, nor the intensity of a single symptom which 
can establish a fundamental difference between two diseases. 

Hectic fever, in consequence of any chronic inflammation 
whatever of the skin, sometimes exists with, and sometimes 
without symptoms of chronic gastritis: this consideration is not 
unimportant, in a practical point of view. 

Hectic, arising from a moral cause, is, according to M. Brous- 
sais, marked by the following symptoms: a sad and morose air, 
aversion to society, the predominance of some particular idea, 
a neglect of the duties of life, and even a neglect to satisfy the 

61 



482 PHYSIOLOGICAL PYRETOLOGY. 

wants of nature; we, likewise frequently observe palpitations, 
mournful sighs, tears, a profound alteration of the features and 
pulse, if the patient be suffering from nostalgia, and his country 
or persons dear to him are made the subjects of conversation. 
This fever, evidently, depends upon a cerebral irritation, accom- 
panied or not by gastritis; but, to complete the picture, we must 
add to it all the characteristic signs of melancholy, epilepsy, and 
catalepsy, which are often accompanied with the symptoms com- 
mon to all hectic fevers. 

I shall not pursue farther the exposition of the phenomena, 
so variously presented by subjects affected with hectic fever. It 
covjld easily be demonstrated, that there is not a single organ, 
however unimportant, which may not, when it is the seat of a 
chronic inflammation, give rise to the symptoms of this fever. 

I shall not enter upon an investigation of the causes of hectic 
fever; they are those of all chronic inflammations: like those of 
acute fevers, they never act at the same time upon the whole 
economy, nor do they always involve the gastric mucous mem- 
brane, although this membrane most frequently feels their in- 
fluence. 

Death is necessarily the natural termination of the hectic fever, 
unless a happy change supervene either spontaneously, or in 
consequence of medical treatment. It is always more difficult 
to cure than acute fevers, with the exception of the adynamic 
and ataxic, and the facility of its treatment must always be in 
proportion to the attention with which the nature and seat of the 
organic lesions, always local, which occasion it, are studied. 

The subject of M. Broussais' thesis, was the hectic fever, in- 
dependent of any irremediable lesion in the structure of the or- 
gans; on this subject, it is not possible to establish rules of a 
very positive character. All that can be said, is, that the case is 
not hopeless as long as the patient is not reduced to the last de- 
gree of marasmus, and is free from a dropsy or diarrhoea, which 
would carry him off in a short time. 

The distinction which M. Broussais has thought proper more 
recently to establish between the hectic of pain and the hectic of 
resorption, appears to me of little utility and of doubtful pro- 
priety. When an organ which has undergone a profound altera- 
tion in its tissue, begins to suppurate, hectic fever becomes aggra- 
vated; when the pus does not find an issue externally, it forms 
a new cause of irritation, and adds to the intensity of the fever; 



CHRONIC FEVERS. 483 

finally, when the introduction of air into the focus of disease 
adds anew to the irritation, the fever becomes still more intense: 
upon these facts the distinction of M. Broussais is founded. The 
diarrhoea which so often attends the last period of hectic, always 
depends, as M. Broussais has demonstrated, upon inflammation 
of the intestines; it is the symptom of a sympathetic inflamma- 
tion which aggravates the primitive and which precipitates the 
fatal termination. 

On post mortem examination, we almost always discover pro- 
found and unequivocal traces of inflammation in one or more 
viscera. These traces, being profound, the organic tissues en- 
tirely altered, destroyed, or in a state of suppuration, the symp- 
toms observed during life, and the death of the patient, are rea- 
dily attributed to them. There is no hesitation about admitting 
the secondary or symptomatic nature of the hectic fever. What 
then should cause a different mode of reasoning when we find 
similar traces of less predominance, after acute fevers? If there 
be nothing repugnant to reason in attributing death to a morbid 
state, which leaves very marked traces after having occasioned 
phenomena of little prominence, how can we refuse to attribute 
death to a lesion of the same nature; which leaves, it is true, less 
profound traces of its existence, but which gives rise to very re- 
markable though rapid phenomena during life? 

There are cases of hectic fever of very unfrequent occurrence, 
and of which I have observed a single example, in which autop- 
; sy reveals no lesion. Must we then conclude, that this fever is 
| owing to the affection of no organ? To draw this conclusion, 
| would be to misapply the researches of pathological anatomy, and 
; to shut our eyes against the lights furnished by the symptoms. 
! These cases are, I repeat, very unfrequent; in most of those 
| which have been reported, it is probable that chronic inflamma- 
tion of the mucous membrane of the digestive organs, of the 
! arachnoid, or of the brain has existed, although it has escaped 
I observation. Even in the case which I have mentioned, I would 
■ not affirm that the arachnoid was free from lesion, for at the 
1 time when I saw the case I was but little acquainted with certain 
| pathological states of this membrane. We know, at the pre- 
sent day, that nostalgia does not occasion death except by super- 
inducing chronic gastritis or chronic inflammation of the menin- 
ges; I should add, of the brain likewise, if the signs of chronic 
encephalitis were better known. Gastric hectic fevers are the 



4 ^4 PHYSIOLOGICAL PTBETOLOGT. 

most common ; next in point of frequency are die 

nic and pleuritic, almost always complicated with the former, es- 

zz:.i..r .1 ihclr *i:m: z-iz.: :. 

T:.r ::-i::.:.i:.: : :' ':-.:::: 'zt^zs lust: :r ::z:z.: ;-^~z:i- 
of the longs, was hot imperfectly known when M. Broos- 
his History of the Chrome Phlegmatism The 
::' zhti.zz iz'-'.-S' :z7.z::.:z. :>: *.h = 
b:i.ie ::" :ir s::~i:i. ifst :z.zizzzzii:'.:z ::" this 
supervene on that of the longs, and accelerate the £ital 
tkm, was not sufficiently understood. The treatment of gastric 
hr-::I: iV^rs —is : : ~ :^:i> r_-. .5. - :ir-:.: : .'. "it :i_s<r :Jir r.ri :: 
the internal membrane of the stomach and intestines in these 
was imperfectly known. As to the others, die remedial 
resorted to in them were dictated by a vague idea of 

ten, M. Broossais demonstrated, in a superior manner, the ne- 
cessity of limiting the treatment of these fevers to the adminis- 
tration of diluent, mucilaginous, edulcorated and sometimes aci- 
drinks; to supparatives of the skin and cellular mem- 
do not augment the irritation against 
which they are employed; to the removal of every irritating 
Mist :.!-£:".= : :' zz^w.zz. r. : : i:.\j :z~ : .77'.:i:a i :rp~. ::: .:lr- 
wise those which are sympathetically connected with it 

At the present day, M. Broossais adds to these simple means, 
an exposition of which may be found in his History of the 
CJirzii: Fr-'-rmiiis, -~:z-s i" e: .:. s~i^ i-micr** ni niir-e 
:; Icii i-r::ri--lj. is it.ir is "■:si.:"r :: :_:i :i.ii~ii ::p:.. 

Such appeals to be the general method to be followed in the 
:.;rii:.:n: : :" r.f-:::: frver?. .i i:i.:.:i :: lii : :s^;~i- :i ::" i^ 
i.;.r r_'.is :■: Hjr= :i. ::.: :.-.-= Sr^/i :^!r:: :i:.:i:=i :n m:s: 
cases, especially when the digestive passages are the seat of in- 
z\iz:.zz.v..\z. T.ir s::tss :: :.:..s z:.=z.:.-.z is :r i: ~r::s :':i- 
auent; but, were bitters and excitants of every kind, formerly 
s-: '.!-.::!;. ::rs:;.:ii ~.z :it-f.= i.susrs ::" r:ti:i: rzi:i:v : Hn 
LirT i:-. :>.c :.5i:-n;-r :: iiiti.i.; .; vie z.Y. efe::> ::' 
:.-.c iiTi-n^is ::' ---.:.-. ~ t:t h:— rT^r :r::^-.sii. 
r, to affirm that blood-letting in small quantity, and the 

fevetBj is not to exelade the employment of certain to- 

■--= .-i.:.ii.:l iriicirs ::iei:". 
I lit- :: -„:.-t:tss.ijT -..; :t~ t-sr-ivt :r.t err;: ::' ;tru:.- pn:- 



CHRONIC FEVERS. 485 

titioners, who still persist in the exhibition of bark, in hopes of 
curing hectic fever when they are totally incapable of operating 
upon the proximate cause of this disease. They obtain this re- 
sult only by augmenting the inflammation of the stomach, when 
this organ is the seat of the disease, or by determining a gastri- 
tis when the inflammation resides in another organ. Thus, with 
a view to the removal of symptoms, purely secondary, they aug- 
ment the intensity of the primitive disease, or rather they create, 
so to speak, another disease; a remarkable example of the unhap- 
py results of therapeutic methods founded solely upon the study 
of symptoms. 

When, however, the stomach is free from disease, and when 
the local symptoms of chronic irritation occupying another or- 
gan are but little marked and the subject not very irritable, we 
may attempt to render the paroxysms less frequent by the exhi- 
bition of the sulphate of quinine; but we must direct its employ- 
ment with a prudent reserve, and remember that we can only ex- 
pect to palliate the disease and not to cure. 

A symptom, the removal of which is often attempted, is the 
sweat and colliquation of hectic fevers, which, it is said, exhausts 
the patient, and should be moderated because it is not critical. 
I have seldom seen the means used with a view to diminish or 
arrest this evacuation succeed, and when they have produced this 
effect, I have constantly observed an exasperation of the fever, 
or the local symptoms of the disease. That this abundant and 
almost continual loss of the nutritive materials of the system con- 
tributes to the destruction of the patient, cannot be denied; but, 
that with a view to oppose it, it is proper to stimulate the gas- 
tric mucous membrane is in direct opposition to the principles 
of sound physiology: experience demonstrates the bad effects 
of tonic and astringent means in such cases. All that can be 
done is to cover the body with dry and hot cloths, often renewed, 
as soon as this symptom establishes itself, and to administer a cold 
acidulated drink if the state of the stomach and lungs permit. 

Since it is proved, that hectic fever is only a collection of the 
symptoms which characterize a chronic irritation, the sympathe- 
tic influence of which extends to the heart, it is only by attack- 
ing this irritation that we must combat the sympathetic pheno- 
mena which characterize the disease. 

It is proper, in a practical point of view, to distinguish two 
varieties of hectic fever, the one with and the other without gas- 



486 PHYSIOLOGICAL PYRETOLOGY. 

trie irritation; in the second, we may occasionally employ cer- 
tain stimulants as derivatives, but with great caution, from the 
apprehension of producing the bad effects which I have men- 
tioned; whilst in the first, that is to say, in that in which the 
gastric passages are primitively or sympathetically irritated, 
every attempt at derivation must be hurtful, by accelerating 
the progress of a disease which tends to destroy the organism. 

When, notwithstanding the means used for their cure, and 
sometimes in consequence of these means, intermittent fevers 
prolong themselves indefinitely, the digestive functions become 
deranged, and, if the stomach has not hitherto been irritated, it 
becomes so, not only in paroxysms but in a continued manner; 
the gastritis increases at each exacerbation, and becomes every 
day more intense; signs of chronic inflammation of the liver 
and spleen manifest themselves; these viscera acquire an extra- 
ordinary size, and become painful on pressure: this is what is so 
improperly denominated obstructions. The intermittent fever, 
as I have already remarked, then assumes the name of splanch- 
nic. The patient constantly grows thin and weak; the febrile 
paroxysms generally become erratic; at other times they return 
or assume the tertian or quartan type; by degrees they pass to 
the continued remittent type, especially when the alteration of 
the tissue of the organs affected tends to suppuration or ulcera- 
tion. The fever is, however, frequently observed to remain 
intermittent. It finally terminates in marasmus, which acquires 
the highest degree of intensity, and the patient dies dropsical or 
worn out by diarrhoea. 

Chronic intermittent fevers present so great a variety, that it 
is impossible to give a general description of them; there are 
still important researches to be made upon this as upon so many 
other interesting points of pathology. 

On dissection, we most frequently detect profound alterations 
in the tissue of the abdominal viscera, in the liver, spleen, me- 
sentery, epiploon, pancreas, kidneys, ovaria and uterus. They 
are, likewise, found in the thoracic viscera. Traces of inflam- 
mation are often found in the peritoneum, pleura, and pericar- 
dium. In a word, we detect the same organic lesions, as after 
chronic continued or hectic fevers properly so called. 

By what strange contradiction is it that the same authors, who 
have attributed the symptoms of chronic continued fever to the 
affection of the viscera, which, on dissection, were found altered 



CHRONIC FEVERS. 487 

in their structure, have attributed these same lesions to chronic 
intermittent fever when dissection revealed them after the latter 
disease? It is not, we confess, the scirrhus of the liver, nor the 
friability of the skin, nor the declining of the peritoneum, nor 
the hydrops pericardii, nor the ascites found after death; it is 
not, we say, these disorders, which have given rise to the fe- 
brile paroxysms; but these alterations indicate that the viscera, in 
which they are observed, have been the seat of an irritation, of 
which the febrile paroxysms were but the symptoms, and which 
has itself determined these alterations of texture. 

The author of a treatise on intermittent fevers, attributed to 
Senac, and all those who have treated of organic lesions pre- 
sented by subjects after chronic intermittents, have scarcely 
mentioned the state of the gastro-intestinal mucous membrane, 
because they were unacquainted with the traces, often slight, 
which inflammation, even the most intense, leaves in this mem- 
brane. The author* just mentioned, remarks that in men who 
have died suddenly after a meal, when they appeared to be cured 
of the fever, the stomach has been found very much dilated, and 
containing water and food; that after prolonged intermittents, 
the intestines are often much dilated in certain parts of their 
extent, and contracted in others, that the colon especially pre- 
sents contractions in its descending portion, a little above the 
! rectum. 

The affection of the abdominal viscera, rendered manifest by 
I an analysis of the symptoms and by dissection, although it has 
' not yet been sufficiently studied, demonstrates that when inter- 
| mittents pass to the chronic state, they necessarily become gas- 
| trie. If we reflect upon the results of treatment, we shall rea- 
| dily find proofs of this assertion; who does not know that these 
fevers are generally attacked in vain by bark? 

One of the most interesting problems in pathology, is, doubt- 
less, to discover what principles should direct the practitioner 
in the treatment of intermittent fevers, with a view to the pre- 
i vention or cure of the obstructions? 

The best means, as we have already remarked, of preventing 

structural alteration of the viscera in intermittent fever, is to ar- 

j rest the disease as soon as possible, by the administration of bark, 

* De recondita Febrium Intermittentium turn Remittentium natura et 
j earum curatione. Geneva, 1769, in 8vo. p. 196-198. 



488 PHYSIOLOGICAL PYRETOLOGY. 

after the careful employment of regimen and blood-letting, and 
the removal of the causes which might reproduce the disease. 

When obstructions exist, if they are ancient, or have existed 
one or more years, there is no hope of obtaining their resolution: 
some happy exceptions confirm rather than confute this proposi- 
tion. In such a case, all we can do is to guard against any thing 
which may aggravate the condition of the patient. 

If the gastric passages are but little irritated, if the obstruc- 
tions have been of but few months' continuance, we may attempt 
to arrest their progress by administering bark with the view of 
putting a stop to the periodical congestions, which gradually ag- 
gravate the morbid condition of the viscera. We have some- 
times the satisfaction of witnessing the disappearance of tume- 
factions of the spleen, liver and mesenteric ganglions, which, to 
all appearance, had been hopeless. Cold or hot water charged 
with a small quantity of salts, abounding in carbonic acid gas, 
gaseous and slightly saline waters, sulphurous waters administered 
internally and in baths, are often of great advantage, and prefe- 
rable to all other deobstruants. In the course of this treatment, 
the local abstraction of blood from the epigastric region, from the 
right or left hypochondrium or anus, may become necessary. 
The regimen should be accommodated to the state of the stomach, 
and should always be severe. 

When the obstructions are recent, the gastric irritation is 
almost always unequivocal; the viscera are painful on pressure; 
we must then be careful not to administer the bark before we 
have employed local blood-letting, regimen, baths and aqueous 
drinks; we must not, however, delay the employment of this 
medicine as soon as the state of the stomach seems capable of 
supporting it. In this manner we frequently prevent the deve- 
lopment of dropsy, a formidable secondary affection, the treat- 
ment of which, cannot find a place in this work, and which al- 
most always announces a fatal termination. 

These principles of treatment should, in my opinion, take the 
place of those which would inculcate either the indiscriminate 
employment or rejection of this medicine, whenever there ex- 
ist any signs of obstruction. 

When chronic intermittent fevers pass to the continued type, 
the administration of the bark cannot but be injurious: the treat- 
ment must, in this case, be entirely palliative, until death termi- 
nates the sufferings of the patient 



OF SIMPLE, COMPLICATED FEVERS, &C. 489 



CHAPTER XVI* 

Of Simple and Complicated Fevers; of Essential or Primi- 
tive Fevers; of Symptomatic or Secondary Fevers, and of 
Humoral Fevers. 

Had I attempted, at the commencement of this work, to give 
an exact idea of the real value of these denominations, I could 
not have avoided the interminable discussions to which the sub* 
ject has given rise; but in the present case, my task has become 
easy. Formerly, that was called a simple fever, which appeared 
to be exempt from all association with a local, inflammatory, bi- 
lious, nervous or verminous state, or with a fever of any other 
character. If the use of this term be continued, it should only 
be employed to designate, every irritation of a single organ, the 
influence of which extends to the heart; and still more properly, 
a primitive irritation of this organ which is partaken to a greater 
or less extent by the vessels. 

Complicated fevers present diverse combinations of inflamma- 
tory, bilious, adynamic, &c. symptoms; that is to say, in these 
diseases several organs simultaneously irritated, contribute to 
call the sympathies into play. 

The name of essential fever has been appropriated to designate 
acute diseases, in which there appears to exist no local irritation, 
to which the production of the febrile phenomena can be attri- 
buted: but as this does not appear to be the case, except when 
we neglect to refer the symptoms to the organs in which they 
I manifest themselves, and to investigate the order of their ap- 
pearance as well as their dependence, and do not attribute the 
| symptoms to the organic alterations found after death, in similar 
cases, we may conclude that no disease merits this name. 

Every physician recognises as a symptomatic fever, that in 
which the irritation of one or more organs is so manifest that no 

62 



490 PHYSIOLOGICAL PYRETOLOGY. 

one can deny its existence: now, it has been demonstrated that 
this is the case in all fevers, and the presumption of Sauvages is 
converted into certainty.* 

A primitive fever is only an idiopathic local irritation, which 
calls the sympathies into play. 

When the local irritation which excites the sympathies is itself 
the sympathetic effect of another irritation, it is called secondary 
fever. 

An essential fever is said to be complicated with an inflamma- 
tion, a neurosis or a hemorrhage, when in a fever which is not 
considered as depending upon a local irritation, unequivocal 
signs of inflammatory, nervous or hemorrhagic irritation, mani- 
fest themselves in an organ which has not hitherto appeared to 
be more affected than any of the others. This appearance of new 
symptoms, occurs sometimes in the organ, the irritation of which, 
hitherto unobserved, produces the febrile symptoms, and in this 
case, the fever denominated essential complicated, is only an 
irritation attended with febrile symptoms, and which augments 
in intensity; sometimes in a different organ from that, the irrita- 
tion of which, produces the febrile symptoms, and in this case, 
there is a true complication : not in consequence of the super- 
vention of a new disease, but owing to the extension of the dis- 
ease which already existed, to an organ which had not pre- 
viously been affected, or at least, not to the morbid degree. 

When a fever manifests itself in the course of any morbid af- 
fection, whatever the febrile symptoms are, it is the result of a 
local irritation which augments or develops itself in an organ, 

* The division of fevers into essential and symptomatic, is not less erro- 
neous than that of the Galenists: they call those symptomatic, which are the 
effect of another disease, and those essential, which are not derived from any 
other disease. But since, according to the moderns themselves, 1st, fever is 
caused by an obstruction of the capillaries, or by irritation of the heart, or by 
derangement of the nerves, and since, by their own avowal, these de- 
rangements are true diseases, or a vicious state of the solids and fluids, 
whence arises the lesion of the functions, it follows, from these principles, 
that all fevers are symptomatic, and that there is no essential fevers : 2ndly, 
because a cause regarded as cause, is never sensible, the effect as effect, is 
not more so; the same remark applies to symptom considered as symptom, 
Sauvages, t. 1. p. 363.| 

t See my article Fctcr in the Dictionnaire Abagte des Sciences Medicates, t. vii. p. 350, Pa- 
ris, 1N2. 



OF SIMPLE, COMPLICATED FEVERS, &C. 491 

the seat of this affection, or is the result of an irritation which 
establishes itself in another organ. In the latter case, the fever 
is truly secondary, or, if the expression be preferred, sympto- 
matic. 

Consequently, every fever is essential, inasmuch as it exists: 
no fever is essential, if by this we mean that it exists by itself, 
which signifies nothing when we speak of a disease. 

It is proper to distinguish primitive from secondary fevers, on 
account of the modifications which the treatment undergoes from 
a consideration of the seat. 

These principles being laid down, let us examine what are 
the fevers which precede the inflammations of the skin, accom- 
pany, or succeed them: those which are called exanthematous ; 
fevers which manifest themselves in the course of a phlegmasia, 
a hemorrhage, or neurosis; fevers which develop themselves af- 
ter a wound; finally, fevers which are attributed to a vitiated 
state of the humours. 

1st, The fever which precedes for some days the erysipelas, 
the measles, small pox, and other cutaneous phlegmasia? is al- 
most always owing to gastro-enteritis: to be convinced of this, it 
is sufficient to observe the state of the tongue, the derangement 
of the digestion, and to explore the epigastrium. This fever di- 
minishes when the inflammation abates or ceases in the gastro- 
intestinal membrane, and manifests itself on the skin; when the 
latter is violently irritated, the membrane of the digestive or- 
gans becomes irritated anew, or the very feeble irritation which 
in most cases it retains, increases, and the febrile symptoms ac- 
quire a new intensity. When the irritation of the skin has 
ceased, reaction no longer exists, provided the gastro-enteritis 
does not persist or increase. At any period whatever of the cu- 
taneous phlegmasia?, the gastro-enteritis, and sometimes the sim- 
ple irritation of the skin in a subject, labouring under a predis- 
position, may determine a formidable, or even a fatal irritation 
in the encephalon; derangement of the nervous system is then 
observed to supervene, with prostration, and if the gastro-ente- 
ritis arrives at the highest degree of intensity, the phenomena 
which the ancients attributed to putridity, declare themselves. 
When the symptoms of gastric, mucous, or bilious fever deve- 
lop themselves, the sympathetic irritation of the gastrointesti- 
nal mucous membrane can no longer be doubted. We have now 



492 PHYSIOLOGICAL PYRETOLOGY. 

sufficiently indicated the nature of gastric, bilious, mucou3, atax- 
ic, and adynamic fevers, which, in the language of the present 
day, supervene on phlegmasia? of the skin, and the treatment 
necessary to arrest their progress. 

The bronchia, and other internal organs, frequently become" 
affected, either conjointly with the digestive organs, or indepen- 
dently of them. 

2dly, A peripneumony, a peritonitis, or a metritis, frequently 
throws the patient into a profound prostration, or determines 
symptoms called nervous. For this to occur, it is not necessary 
that the gastro-intestinal mucous membrane be in a state of in- 
flammation; but when vomiting, diarrhoea of fetid matters, and 
an acrid heat of the skin are superadded to prostration, it can no 
longer be attributed to the inflammation of the lungs, uterus, or 
peritoneum: there is evidently gastro-enteritis. The same prin- 
ciples, tlien, apply to these gastric, adynamic, and ataxic fevers, 
as to those which complicate phlegmasia of the skin. 

When one of these fevers manifests itself in the course of an 
irritation called nervous, cerebral irritation very readily super- 
venes, even when there is no gastritis. 

The remarks which I have made in relation to the fevers 
which complicate inflammation, apply equally to hemorrhages of 
the lungs, of the uterus, &c. 

In speaking of chronic fevers, in the preceding chapters, I 
have indicated, as far as I could in this work, the points of doc- 
trine relative to the connexion of chronic diseases with febrile 
symptoms. 

3dly, Traumatic fevers comprehend the synocha, the bilious, 
adynamic, and ataxic fevers, which manifest themselves after 
wounds. 

The first is the direct effect of the irritation, pain, and inflam- 
mation, inseparable from a solution of continuity, however slight, 
v affecting irritable parts: very often a sympathetic gastro-enteritis 
supervenes with rapidity, and -contributes to the development of 
the febrile symptoms. The constitution of the patient, and the 
circumstances to which he is subjected contribute much to the 
production of these symptoms. 

The second is always the effect of an intense gastro-enteritis, 
involving more or less the liver: there are certain wounds, such 
as those of the head, which determine it more readily than 



OF SIMPLE, COMPLICATED FEVERS, &C. 493 

others. It is far from being in every case, as it has been assert- 
ed, the effect of a bad regimen. Since a bad regimen had not 
occasioned it before, it can, at most, only predispose to it, unless 
the wounded be guilty of excess, or make use of too abundant 

' succulent or gross an alimentation. Traumatic febrile gastroen- 
teritis manifests itself more frequently during the heats of sum- 

i mer. When it assumes a high degree of intensity, it gives rise 
to traumatic adynamic fever. 

If the irritation of the stomach be transmitted to the encepha- 
lon, the nervous phenomena are observed which characterize 
what is called ataxy. But these phenomena are often the direct 
effect of the traumatic irritation upon the encephalon, as it is ob- 
served after amputations. 

It appears from the preceding remarks, that in every fever, 
essential or primitive, symptomatic or secondary, and in every 
complicated fever, it is important to know, not only the organs 
which have suffered lesion, and those which have suffered to the 
highest degree, but likewise those which have been the first af- 
fected, and without the irritation of which the others would not 
have suffered. 

I think that it may be logically deduced from these facts, that 
all essential or primitive fevers, and that all symptomatic or se- 
condary fevers, are not to be attributed to gastro-enteritis; and, 
therefore, that it is always important to distinguish the cases in 
which the stomach and intestines are irritated, from those in 
which they are either not at all, or so slightly affected, that it is 
not necessary to address the curative measures to them, or, at 
least, not to them exclusively. 

If in all generic descriptions of fevers, we find the symptoms 
of gastro-enteritis, it is not because the latter occur in all the 
particular cases which have served as the basis of these descrip- 
tions: it only proves that this inflammation occurs in many of 
them; otherwise it would be necessary to say that cerebral irri- 
tation occurs in all, because the phenomena of this irritation finds 
a place among the symptoms. It is thus, that in consequence of 
a faulty method of description, and a mania for groups of symp- 
toms, that nothing but general diseases, or gastro-enteritis, have 
been seen in diseases altogether inflammatory and circumscribed 
in their seat, but invading at different times one or several or- 
gans. 



494 PHYSIOLOGICAL PYRETOLOGY. 

If these principles are in conformity to truth, and if they are 
adopted in practice, we shall not so frequently witness the exhi- 
bition of medicines, in the course of fevers, without the slightest 
regard to the state of the organs to which they are applied; and 
this will be the happy result of the theoretic and practical re- 
searches of M. Broussais on the nature and seat of fevers. Phy- 
sicians will then less frequently endeavour to stimulate the brain 
by the internal exhibition of tonics, when the principal seat of 
the disease is the gastro-intestinal mucous membrane; and, on 
the other hand, they will be less intent upon combating, in cer- 
tain ataxic fevers, a gastric irritation, which does not exist, or 
which no longer exists, or which is only the sympathetic effect 
of a cerebral irritation. The progress of observation renders 
the consummation of these hopes every day more probable. 

Finally, Whence is it that, in the year 1S30, we are reduced 
to the necessity of combating the errors of the middle ages? It 
is to be ascribed to the nature of the human mind, which ad- 
vances but slowly in the road of truth, and by many and circu- 
itous paths, which, returning incessantly to the point of depar- 
ture, seem to render illusory the progress of science, manners, 
and institutions. 

That at a time, when, from the imperfection of anatomical sci- 
ence, the human body was considered by the most learned phy- 
cians as a sort of machine containing liquids, in which life and 
its functions existed, and that when all diseases were attributed 
to the superabundance, penury, and alteration of these fluids, fe- 
vers were explained by this absurd theory, and that humoral 
fevers were then admitted, is not astonishing. A fever was 
cured after hemorrhage; the blood was then considered as its 
cause; another ceased after a vomiting of porraceous matter, and 
was, therefore, attributed to the bile; another after a mucous ex- 
pectoration, and consequently the phlegm was its origin; ano- 
ther proved fatal, notwithstanding copious dejections of black 
matter: and here the atra-bile had not been evacuated in suffi- 
cient quantities, and the material cause of the fever not having 
been eliminated, the patient must necessarily perish. This mode 
of reasoning justified itself by the maxim, so common among 
the ignorant, and in the imperfection of knowledge too frequent- 
ly applied even by the learned, Post hoc, ergo jiropter hoc. 



OF SIMPLE, COMPLICATED FEVERS, &C. 495 

But it is certainly astonishing, that, at the present day, men, 
among whom are to be found some of the most intelligent, 
should be pleased, without any alarm, at the deluge of errors 
with which the humoral theory had absolutely drowned the sci- 
ence of diseases, to repeat unnecessarily that there is something 
true in the ancient humoral pathology, that certain fevers cannot 
be referred to any organ, and that, therefore, the inference is 
probable that they affect the humours, and that in this case the 
fever is general. It is certainly not very consistent with good 
logic, to say that there is something true in a doctrine, without 
pointing out what there is in it conformable to observation and 
reason: we cannot, consistently with correct physiological views, 
consider the fluids as any thing but what they are made by the 
organs. When foreign matters are introduced, they are no longer 
themselves, and this does not occur unless some organ is affect- 
ed; ignorance of the organic seat of a fever does not authorize 
us to consider a fever as seated in the humours, in which hitherto 
no disease, properly so called, has been demonstrated. When 
it shall have been proved that a humour may undergo a sponta- 
neous alteration, like cider in a barrel, as it has been said to do, 
by one who is better entitled to the name of technologist than 
physiologist, it will still remain to determine what organs re- 
ceive the febrifacient impression of this humour. It will, be- 
sides, be necessary to demonstrate that the alteration of a whole 
humour, of the blood for example, without the alteration of any 
organ, constitutes a disease of the whole body, as though the or- 
gans formed no part of the economy.* 

An abundance of blood, resulting from an energetic alimenta- 
tion, may sur-excite the heart, lungs, brain, and uterus; the pre- 
sence of bile may irritate the digestive passages; that of the 
urine, the bladder: fever may be the result; but what do we 
know of the effects of the alteration of these liquids, or of the 
alteration itself? 

We call upon experimentalists, anatomists, chymists, and prac- 
titioners to endeavour to penetrate these mysteries, by experi- 
ments, dissections, chymical analogies, and clinical observations; 
not by hasty conclusions, unfounded hypotheses, and reveries, 
which might afford matter of laughter to the public, were they 
not couched in the unintelligible jargon of pretended science. 

* Gcrdy, Transactions Medicales. 



496 PHYSIOLOGICAL PYRETOLOGY. 

Nothing is more to be suspected than that ardent desire to an- 
ticipate the progress of knowledge, which frequently betrays the 
finest intellects into the adoption of errors. 

In proportion to the progress of pathological anatomy, humo- 
ral fevers have become organic diseases; and even Pinel wished 
to banish every Galenical explanation from his theory of fevers. 
If we are bound to reject no fact, much more are we bound not 
to advance hypothesis before certain knowledge. No one, at 
the present day, flatters himself with the idea that he has pene- 
trated the ultimate secrets of nature, in relation to the state of 
the solids, either in a pathological or physiological condition; 
but we at least possess, in relation to these parts, an imposing 
mass of facts, derived from clinical observation and dissection. 

Can the same be said of the fluids? Symptoms only lead to 
suppositions; autopsy has taught us nothing that was not known 
at the time of Mondini; chymical analysis has shown only simi- 
larity of composition, and rarely any difference; the slight alter- 
ations of the blood with which we are acquainted not being 
discoverable by any certain signs during life, can furnish no 
principles in pathology, and can be the subject of no indications 
in therapeutics. They can, therefore, have but little interest 
for the practitioner, who adopts no theories but those which are 
indispensable for the classification of facts, and the study of the 
organs, which permits no fact to be lost, has the farther advan- 
tage of placing them before the eye in all their nakedness. * 

* Nosographie Organique, tome iii. Alterations du Sang. 



OF FEVER. 497 



CHAPTER XVII. 

Of Fever. 

After having sought in a physiological study of the causes and 
symptoms of the fevers described hy the most celebrated pyre- 
tologists and in the results of post mortem examinations, positive 
data in relation to the nature and seat of these diseases, it is pro- 
per to study fever in general, to determine in what it differs 
from inflammation, and to establish the most general rules of its 
treatment 

Should it be objected, that fever is only a word, and that in- 
flammation is a fact, I would answer, that if fevers are only 
phlegmasia?, the word fever expresses a fact as well as the word 
inflammation, and that the subject of the present chapter is a 
comparison of the inflammations which have received the name 
of fevers, with those to which no one refuses the name of phleg- 
masiae. 

Galen and his numerous commentators have defined fevers — 
a heat contrary to nature, developed in the heart, and which, de- 
parting from this organ, diffuses itself by the spirits and the blood, 
by the arteries and veins, through the whole body. This heat 
is sometimes excessive, and produced by the simple augmenta- 
tion of the native heat inherent in the animal; and sometimes 
i the product of a putrescent, malignant or pestilential matter, de- 
veloped in the living body or introduced into it. 

To constitute fever, it was considered necessary that this heat 
should be durable and involve the whole body. Its characteristic 
signs were — a quick, frequent and sometimes unequal pulse, lan- 
i guor, dejection, a sense of acrid heat of the surface, or only an un- 
pleasant sense of heat internally. Avicenna and Fernel made 
the important remark, that this heat might arise in other parts 
besides the heart, although it always involved this organ at last. 

This theory offers us, on the one hand, all that could be 
learned in the infancy of medicine from an observation of the 
symptoms, and, on the other hand, the hypothesis of innate 

63 



498 PHYSIOLOGICAL PYRETOLOGY. 

heat and of heterogeneous matters developed spontaneously in 
the organism or introduced into it, that of the spirits, of putri- 
dity and of malignity. The sense of heat experienced by the 
patient, the re-establishment of the health after evacuations, the 
empty state of the arteries after death, certain phenomena com- 
mon to the humours evacuated in inflammation, and to animal 
matters in a state of putrefaction, the occasional occurrence of 
death in the midst of symptoms by no means alarming, were 
the facts upon which were based these hypotheses for so many 
ages, the inexhaustible source of sterile disputes. But if the 
Galen ists erred in considering fever as a general disease, they at 
least suspected its true nature, since they attributed it to heat; 
they were acquainted with the part which the heart performed 
in this disease; and some of them perceived that this organ was 
not always the first affected. Galen himself attempted to deter- 
mine the particular seat of many species of fevers.* More could 
not have been effected in the infancy of physiology and anatomy, 
and when pathological anatomy did not even exist. 

The fundamental ideas of Galen, of the Arabians, and of Fer- 
nel have, until the present period, been surcharged with innu- 
merable subtleties rather than modified. Thus when, in the fif- 
teenth century, Paracelsus attributed fever to the combustion of 
sulphur and nitre, he only referred to an imaginary cause the 
heat, which, according to the Galenists, constituted fever. Ga- 
len had found the rudiments of his theory in certain books of 
the descendants of Hippocrates; Paracelsus, in attacking him r 
commenced the monstrous application of chymistry to patholo- 
gy, which has continued even to the present day. 

Versed in the writings of Hippocrates, Galen and Paracelsus, 
Van Helmont made a singular mixture of the doctrines of these- 
celebrated men. Without regard to the structure of the organs, 
he attributed fever to the terror, the shock, the deranged move- 
ments of the archseus, and placed the seat of the disease in the 
duodenum. They were then better acquainted with the part 
performed by the stomach and small intestine in the production 
of fever; but the imagination of physicians, swayed by absurd 
hypotheses, could not pay much attention to this gleam of truth. 
Yet in the midst ©f these humoro-chymical errors, the inflam- 

* See ray Historical Researches on Fevers. Paris, 1822, in 8vo. 






OF FEVER. 499 



matory character of fevers was not entirely unknown, as may be 
seen in a work, otherwise of little importance, of Henry Screta 
Schitnor de Zavorziz;* and even in those of Sydenham, who, 
as remarkable for his powers of observation as he was for the 
errors of his theory, attributed fever to an effort of nature to ex- 
pel by fermentation the morbific cause. 

Borelli attributed this disease to an irritation of the heart, 
owing to the acridness of the nervous fluid. Bellini to the stag- 
nation and thickening of the blood in the capillary net-work, the 
effect of the irregular movements of this liquid. 

Chirac, an admirer of the chymical and mechanical theories, 
beheld in fever, at one and the same time, the effect of the fer- 
mentation, the stagnation and irregular movement of the blood; 
but to him belongs the credit of having first positively asserted 
that we could arrive at a true knowledge of disease only by post 
mortem examinations. t 

Stahl demonstrated, that in fever the blood is not in a state of 
stagnation: he attributed this disease to an excitation of the tonic 
movement of the solids; he thought that this increased "action 
was provoked with a salutary object by the soul, and he admit- 
ted no difference between fever and inflammation. 

Glisson had long since published the fine and pregnant idea of 
; the irritability of the organic tissues, when F. Hoffman attributed 
I fever to a spasm of the periphery, which pushed the blood to 
: the internal parts; he established no other difference between 
inflammation and fever except the greater extension of the lat- 
i ter. He declared that all the subjects whom he had seen perish 
in fever, had died in consequence of an inflammation of the sto- 
mach, the intestines and meninges. 

Bordeu, although he contributed to the rejection of many ]u- 
minous ideas of Chirac, yet admitted the analogy of fever and 
! inflammation. He was the first to perceive the utility of naming 
: -each fever according to the organ most affected. 

A disciple of Glisson, Hoffman, and Cullen, Brown attributed 
the intermittent and continued fevers called nervous to astheny, 
and the synocha to sur-excitation. To these fundamental ideas 
may be referred all those which have served as the text of the 

* De Febre Castrensi Maligna seii mollium Corporis Humani partium In- 
flammatione dicta. Bale, 1716, p. 26. 
t Op. cit. tome i. ch. ii. art. 10 et 11. 



500 PHYSIOLOGICAL PYRETOLOGY. 

innumerable works on fever, published from the time of Galen 
to the commencement of the present age. Among these ideas, 
those which were most conformable to information obtained the 
fewest partisans: no one acquainted with the history of pathology 
can be astonished at the disgust which Pinel manifested to the 
theories of the schools at the time of the publication of his No- 
sography. 

This professor did not, however, think it contrary to the pro- 
per method of study in natural history to attribute certain fevers 
to irritation, others to weakness, and others to the irregularity of 
the functions: it is probable that he would not have blamed those 
of his predecessors who had written on fever in general, if he 
eould himself have attained to a general idea, which might em- 
brace the three proximate causes, by the aid of which he ex- 
plained the production of all fevers. 

It is at the present day demonstrated, that all fevers are owing 
to a local irritation of greater or less extent; that if the weakness 
sometimes precedes this irritation, accompanies it in another or- 
gan, or follows it, the irritation is the only source of the symp- 
toms of reaction and the premature source of the symptoms which 
seem to indicate weakness; finally, that we should never assign the 
first rank to those symptoms which really denote astheny of an 
organ, because this weakness either does not constitute the disease, 
or it is the effect of the irritation which constitutes the latter. 

I shall not attempt to prove that the acceleration and force of 
the pulse and heat of the skin are not signs of weakness; the 
time when such errors prevailed is long passed. But among 
those physicians who admit that the symptoms of fever, are, if 
not always, at least most frequently the effect of a local irrita- 
tion, and especially among those, who, while they acknowledge 
the extreme frequency of this irritation, still assert that it is ge- 
neral, there are some who deny its analogy to inflammation. 
This error would be unimportant, did it not tend to give an un- 
happy direction to the treatment of fever. It is therefore neces- 
sary to enter into some details upon this subject. 

In what does inflammatory differ from febrile irritation? Is 
it in its causes? But the causes of both are the same, and, were 
they different, it should be in the modifications undergone by 
the organs that a proof of their difference should be sought. If 
we compare the symptoms of fever with those of inflammation 



OF FEVER. 501 

in the first, second, or third degree of these diseases, we per- 
ceive that these symptoms are the same; there is but a single 
point o( difference: it is, that the local or direct symptoms are 
less intense, less manifest, whilst the sympathetic or remote symp- 
toms are relatively more prominent in the first than in the second. 
It appears, then, that fever is generally less intense than inflam- 
mation: but this is only apparently the case. If the sympathetic 
symptoms are very marked in continued fevers, even when the 
local symptoms are but slightly so, it is because the irritation 
then resides in a very excitable organ, of great influence in the 
economy, or that the organs which feel the influence of the or- 
gan primitively affected, are very excitable. Nevertheless, there 
are cases in which the irritation is not very intense, but of great 
extent, invading many organs important to the maintenance of 
life. Because the sympathetic symptoms are always greatly de- 
veloped in fever, let us not conclude that the irritation which 
constitutes it is of a different nature from inflammation; for we 
continually see slight though unequivocal inflammations deter- 
mine sympathetic symptoms of a more marked character than 
those of a more intense inflammation. 

If febrile irritation be sometimes less intense than inflamma- 
tory irritation, let us not be surprised that it leaves in the or- 
gans traces less profound, and which sometimes even disappear, 
at the moment when vital action ceases. Let us also remember, 
that if fever has appeared, during a long series of ages, to leave in 
the organs fewer traces of inflammation, it is because physicians 
sought in the mucous and serous membranes, in the arachnoid 
membrane, for example, disorders as profound, and as evidently- 
inflammatory as those found in the cellular tissue after phlegmon. 

In vain is the cure of certain fevers, under the influence of to- 
nics applied even to the irritated organ, brought forward as dis- 
proving the analogy of fever and inflammation: were these cases 
as numerous as they are uncommon, they would prove nothing 
against our opinion. Inflammation is also cured by stimulants 
applied to the organ in which it is seated. But we know, by a 
treatment so irrational, we hazard the aggravation of this mor- 
bid state, and the destruction of the inflamed tissue. This un- 
doubted fact should not be lost upon the physician, when called 
upon to treat fever: to the presumption of the ephemeral success of 
empyricism, let him prefer the satisfactory certainty that he has 



502 PHYSIOLOGICAL PYRETOLOGY. 

only made use of those means which the nature of the disease 
points out. Would that the innumerable deaths which take 
place in the course of epidemics, notwithstanding the copious- 
ness of our materia medica, and which, at least, evince the effi- 
cacy of tonics; would that the recent progress of pathological 
anatomy might correct the error of those physicians, who, while 
they celebrate the vis medicatrise naturae, act as though they did 
not believe in its existence, and very frequently do more mis- 
chief than if they had remained tranquil spectators of the com- 
bat, in which they believed themselves obliged to take part, at 
the same time that they protest their attachment to the method 
of expectation. 

The intermittent character of fever proves nothing against its 
analogy to inflammation, since inflammation itself is frequently 
intermittent. That irritation in intermittent fevers is sometimes 
less permanent, less profound, of shorter continuance, and of 
greater mobility than inflammation, may be granted, without de- 
nying the identical nature of these two morbid conditions, pro- 
vided we admit that it is at least as acute and not less fatal, al- 
though more rapid in pernicious intermittent fevers. 

To the authors who behold in fever only a nervous irritation, 
it is sufficient to answer that it is nervous when it resides in the 
nerves or in the brain. 

As to those who pretend that fever is only a secretory irrita- 
tion, it is sufficient to refer them to the Galenical theories, which 
they expect to revive under the garb of modern physiology. 

As long as the analogy of fever and inflammation has been, 
if not demonstrated, at least suspected, that is to say, from the 
time of Galen until the end of the last century, physicians, not- 
withstanding their humoral, chymical, and mechanical theories, 
have, for the most part, recognised the utility of blood-letting 
in the treatment of fever; all would have seen that it was indi- 
cated in this disease, even when it appeared to be the result of 
putridity and malignity, had not their minds been preoccupied by 
these erroneous theories. Some among them did not even fear 
to avow that blood-letting was one of the most appropriate me- 
thods of preventing putridity and malignity, and of arresting 
the progress of these imaginary morbid conditions of the hu- 
mours. 

Brown and Pinel limited, to such a degree, the employment 



OF FEVER. 503 

of blood-letting, that there was reason to regret the time when 
their predecessors, persuaded of the necessity of taking blood, 
with a view to diminish the plasticity of this fluid, and to faci- 
litate the circulation, did not fear to resort to this powerful re- 
medial measure. 

To complete the history of fevers, profound researches are yet 
to be made with regard to the complication of encephalic, tho- 
racic, abdominal and cutaneous inflammations, as well as those 
of the muscles, the synovial membranes, and fibrous tissues, 
with irritation of the heart. I have attempted to point out this 
deficiency, rather than supply it. 

Broussais has done much towards the overthrow of the ancient 
pyretological doctrines, but he has only described the gastritis, 
to which the name of fever has been given. As Pinel neglected 
to treat of complicated fevers, so has M. Broussais neglected 
complicated gastritis. 

It remains to determine the frequency and the diagnosis of 
the inflammations of each organ, and of every part of the body 
in fevers. Shall it be said, that it is sufficient to be acquainted 
with the signs of these different inflammations, to recognise them 
in every case? This would be to elude the difficulty. The signs 
of simple and intense gastritis were known before the time of 
M. Broussais, and yet it was not recognised in fevers. 

The time has arrived, when all practitioners, particularly 
those who practise in hospitals, and especially in countries often 
desolated by epidemics, should investigate with care the symp- 
toms of complicated irritations, which are announced only by 
symptoms, hitherto grouped under the name of fevers. 

Many facts are wanting towards the establishment of the treat- 
ment of these diseases on a solid foundation; these facts cannot 
be obtained, except through the united efforts of physicians in 
every country. 

At the present day, when the nature and seat of fevers are no 
longer a mystery, and the advantages and disadvantages of 
blood-letting are positively ascertained, we know in what cases 
it is indicated, and where the application of leeches is prefera- 
ble. Hereafter, the efforts of practitioners must be directed, not 
only to an investigation of the cases in which emetics and tonics 
may be employed without danger in the treatment of fevers; 
but, likewise, to the determination of the place in which blood- 



504 PHYSIOLOGICAL PYRETOLOGY. 

letting should be practised, or leeches applied; the quantity of 
blood which should be taken, the number of bleedings which 
6hould be practised, and the number of leeches which should be 
applied in proportion to the intensity, the seat, and extent of the 
irritation, the period of the disease, the susceptibility and age 
of the individual, and the circumstances which have occasioned 
the disease. They will endeavour to ascertain with greater cer- 
tainty than has hitherto been attained, the cases in which it is 
necessary to treat intermittent fever with bark, and with this in 
view, they will remember that between fever of this type, and 
intermittent inflammation of an unequivocal character, the only 
difference is in the seat, and sometimes in the intensity of the dis- 
ease. And, finally, it will be important to study the powerful in- 
fluence of an absolute, or, at least, very rigorous diet in the treat- 
ment of fever, as well as the effect of derivative stimulants applied 
to the skin, or to the mucous membrane of the great intestines. 
Important results would doubtless be obtained, if physicians, in- 
stead of limiting themselves to the observation of symptoms, 
w T ould carefully engage in post mortem examinations, and submit 
the facts which they might collect to a physiological analysis, 
which alone can place the science of medicine on a firm basis. 

The declamations of certain persons, against the application 
of physiology to pathology, only proves that they are aware of 
their incapacity to attain reputation by direct means, and that to 
attain their ends, they hesitate not to adopt the most indirect 
methods. 

For some time, it has been common to repeat that the physi- 
ological doctrine has fallen into oblivion, and this at the very 
time when it is the source of all that is rational in the writings of 
its detractors, and when every practitioner, professor, and wri- 
ter, draws largely from it in the exercise of his profession, in 
teaching and in the investigation of principles. A most singu- 
lar fact, of a doctrine to make its way against all attempts to ob- 
struct its progress, and to compel its detractors to borrow its 
principles, with a view to exhibit an appearance of novelty. 



THE END. 



JUST lTBUSilKI) JJV CAREY & LEA. 



'RIVATF, MEMOIRS of NAPOLEON 
HOXAPARTK. from the French of M. 

Faim:lkt di: IkuRRIENJIB, Private Secre- 
tary to the Emperor. Sj:iom> Ami:ki< y\ 
Km no\, complete in one volume. 
*.y This edition contains almost a fourth 
()re matter than the previous one, as m order 
vender it as perfect as possible, extracts have 
■n given from the Memoirs from St Helena, 
fecial Reports, &c &c. in all eases where 
bey diller from the statements of M. de Bour- 
leime. 

'•This English translation, which has been 
Jy faithfully rendered, is still more valuable 
ban the original work, as upon all points where 
m obliquity from other published recitals oc- 
urs, the translator has given several accounts, 
ad thus, in the form of notes, we are presents 
i with the statements obtained from Napo- 
»n's own dictation at St. Helena, from the 
pmoirs of the Duke of Rovigo, of General 
f Constant, from the writings of the 
rquis of Londonderry, &c\" — U. Ser. Jour. 
Those who desire to form a correct esti- 
e of the character of one of the most extra- 
inary men " that ever lived in the tide of 
" will scarcely be without it. The present 
ion possesses peculiar advantages. 
he peculiar advantages of position in re- 
to his present subject, solely enjoyed by 
de Bourrienne, his literary accomplish- 
ts and moral qualifications, have already 
'ned for these memoirs the first rank in 
temporary and authentic history. Li 
mce, where they had been for years ex- 
acted with anxiety, and where, since the 
■olution, no work connected with that peri- 
n or its consequent events has created so 
Bat a sensation, the volumes of Bourrienne 
fte, from the first, been accepted as the 
By trustworthy exhibition of the private life 
■id political principles of Napoleon. 
\ " We know from the best political authority 
low living in England, that the writer's ac- 
■Dnts are perfectly corroborated by facts." — 
Jjit. Gaz. 

" The only authentic Life of Napoleon ex- 
}ant." — Courier. 

'-This splendid publication that literally 
Mves nothing to be desired." — Atlas. 
L" These volumes may be read with all the 
■erest of a romance." — Courier. 
1^" No person who is desirous rightly to ap- 
preciate the character of Bonaparte, will ne- 
Ijjct the perusal of this work; whoever 
Bhes to know, not merely the General or 
J Emperor, but what the man really was, 
11 find him well pictured here." — Times. 
"The cornpletest personal recollections of 
(Napoleon that have appeared." — Morn. Post. 
I "As a part of the history of the most ex- 
traordinary man, and the most extraordinary 
Junes that ever invited elucidation, these me- 
[noirs must continue to the latest ages to be 
records of invaluable interest." — Lit. Gaz. 



Tin: BRAVO, by the author 0/ the "Spy," 

" Pilot," " Red Rover," &C, In 2 vols. PJmo. 

" Let us honesily avow in conclusion, that 
in addition to the charm of an interesting fic- 
tion to be found in these pages, tin re 

mental power in them, more matter llial sets 
people thinking, more of that quality that is 
accelerating the onward movement of the 
world, than in all the Scotch novels that have 
so deservedly won our admiration." — iVeie 
Monthly Magazine. 

" This new novel from the pen of our 
countryman, Cooper, will win new laurels for 
him. It is full of dramatic interest — " hair- 
breadth escapes" — animated and bustling 
scenes on the canals, in the prisons, on the 
Rialto, in the Adriatic, and in the streets of 
Venice." — N. Y. Courier c|- Enquirer. 

" Of the whole work, we may confidently 
say that it is very able — a performance of ge- 
nius and power." — Nat. Gazette. 

" The Bravo will, we think, tend much to 
exalt and extend the fame of its author, We 
have hurried through its pages with an avidi- 
ty which must find its apology in the interest- 
ing character of the incidents and the very 
vivid and graphic style in which they are de- 
scribed." 

By the same author. 
The HEIDEN-MAEUR, or Pagan Camp. 

In 2 vols. (In the Press.) 
SALMONIA ; or, Days of Fly Fishing ; by 

Sir Humphry Davy. 

" One of the most delightful labors of lei- 
sure ever seen ; not a few of the most beauti- 
ful phenomena of nature are here lucidly ex- 
plained." — Gentleman 's Magazine. 

NATURAL HISTORY of SELBORNE 
and its INHABITANTS. By the Rev. 
Gilbert White. 18mo. 

The MECHANISM of the HEAVENS, by 

Mrs. Somerville. In 18mo. 

" We possess already innumerable dis- 
courses on Astronomy, in which the wonders 
of the heavens and their laws are treated of; 
but we can say most conscientiously that we 
are acquainted with none — not even La Place's 
own beautiful expose in his System du Monde. 
— in which all that is essentially interesting in 
the motions and laws of the celestial bodies, or 
which is capable of popular enunciation, is so 
admirably 1 , so graphically, or we may add, so 
unaffectedly and simply placed before us. * * * 
Is it asking too much of Mrs. Somerville to ex- 
press a hope that she will allow this beautiful 
preliminary Dissertation to be printed sepa- 
rately, for the delight and instruction of thou- 
sands of readers, young and old, who cannot 
understand, or are too indolent to apply them- 
selves to the more elaborate parts of the work^ 
If she will do this, we hereby promise to ex- 
ert our best endeavors to make its merits 
known." — Literary Gazette. 

1 



MISCELLANEOUS. 



LARDNER'S CABINET CYCLOPAEDI- 



AS HISTORICAL INQUIRY into the 
PRODUCTION and CONSUMPTION 
of the PRECIOUS METALS, from the 
Earliest Ages, and into the Influence of 
their Increase or Diminution on the prices 
of Commodities. By William Jacob, 
Esq. F. R. S. In 8vo. 
" Mr. Jacob's Historical Inquiry into the 
Production and Consumption of the Precious 
Metals is one of the most curious and import- 
ant works which has lately issued from the 
press. The influence of the precious metals 
on the industry of mankind is acknowledged 
to be great ; though, perhaps, the notions re- 
specting the precise mode of its operation 
were obscure, and undoubtedly the history of 
its effects had never been traced with accu- 
racy and ingenuity. Mr. Huskisson, who had 
maintained a friendship with Mr. Jacob for 
more than five-and-twenty years, first put the 
author on the investigation; it is one of the 
minor obligations which the country owes to 
that enlightened statesman." — Spectator. 

" It was written at the suggestion of the 
late Mr. Huskisson, and displays the fruits of 
much industry and research, guided by a sound 
judgment, and embodying more learning than 
is usually brought to bear on statistical or eco- 
nomical subjects. We recommend the book to 
general attention." — Times, Sept. 2,1831. 
NARRATIVE or a VOYAGE to the 
PACIFIC and BEHRIXG'S STRAIT, to 
co-operate with the Polar Expeditions : per- 
formed in His Majesty's ship Blossom, un- 
der the command of Capt. F. W. Beechev, 
R. N. in the years 1825, 26, 27, 23. In 8v"o. 
" The most interesting of the whole series 
of expeditions to the North Pole." — Quarter- 
ly Review. 

" This expedition will be forever memora- 
ble as one which has added immensely to ourj 
knowledge of this earth that we inhabit." — j 
Blackwood' 's Meg. 

" Captain Beechey's work is a lasting mon- 
ument of his own abilities, and an honor to 
his country." — Lit. Gaz. 
A GENERAL VIEW of the PROGRESS 
of ETHICAL PHILOSOPHY, chiefly 
during the Seventeenth and Eighteenth 
centuries. Bv Sir James Mackintosh, 
M. P. In 8vo. 

" This, in our humble opinion, is the best off- 
spring of the pen of an author who in philoso- 
phical spirit, knowledge and reflection, rich- 
ness of moral sentiment, and elegance of style, 



HISTORY of the RISE, PROGRESl 
amd PRESENT STATE of the SI 
MANUFACTURE; with numerous en- 
gravings. 

" It contains abundant information in every 
department of this interesting branch of hu- 
man industry — in the history, culture, and 
manufacture of silk." — Monthly Magazine. 

" There is a great deal of curious informa- 
tion in this little volume." — Lit. Gazelle. 

HISTORY of the ITALIAN REPUBLICS, 
by J. C. L. Sismondi. 

HISTORY of MARITIME and INLAND 
DISCOVERY. In 3 vols. (In the press.) , 
" This book abounds with curious informa- 
tion." — Gentleman's Magazine. 

" The whole work is so filled with variety 
and excellence, that any ten of its pages which! 
we might quote, would prove to readers that 
thev ought not to be satisfied with less than 
all."— Lii. Gazette. 

HISTORY of the RISE, PROGRESS, and 
PRESENT STATE of the MANUFAC- 
TURES of PORCELAIN and GLASS. 
With numerous wood cuts. (In the press.) 

HISTORY of the RISE, PROGRESS, 
and PRESENT STATE of the IRON 
and STEEL MANUFACTURE. (In press.) 

"This volume appears to contain all useful 
information on the subject of which it treats." 
— Lit. Gazette. 

BIOGRAPHY of BRITISH STATESMEN; 

containing the Lives of Sir Thomas More, 

by Sir James Mackintosh ; Cardinal Wol- 

sey, Archbishop Cranmer, and Lord Burleigh. 

" A very delightful volume, and on a subject 

likely to increase in interest as it proceeds. 

* * * We cordially commend the w^ork both 

for v its design and execution." — London Lit. 

Gazette. 

" The life of More, being from the pen of 
Sir James Mackintosh, engaged and fully re- 
warded our attention. It is a rich theme, and 
has been treated with the lofty philosophical 
spirit and literary skill which distinguish the 
writings of Sir James." — Nat. Gazette. 

'• We are certain, that no one can rise from 
the perusal of the work, without having his 
understanding enlarged, and the best affections 
of his heart improved." — Album. 

A. most interesting and valuable volume." 



has altogether no superior— perhaps no equal \ GenL M a S azlne - 

rnong his contemporaries. Some time ago j ELEMENTS of OPTICS. By David Brew- 



we made copious extracts from the beautiful 
work. We could not recommend the whole 
too earnestly."— National Gazette. 
HISTORY of ENGLAND, by Sir James 

Mackintosh. Octavo edition. In the press. 

%* The first volume of this edition will contain the 
same matter as the first 3 volumes of the 18mo edition. 



ster. 18mo. (In the press.) 

" The author has given proof of his well- 
known industry, and extensive acquaintance 
with the results of science in every part of 
Europe." — Monthly Mag. 

" The subject is, as might be expected, ably 
treated, and clearly illustrated." — U. S. Jour. 






r~: 






FA JULY CABINET ATLAS. 






■ 



In preparation. 
JIThe FAMILY CABINET ATLAS, con- 
structed upon an original plan: Being 
a Companion to the Encyclopedia Ameri- 
cana, Cabinet Cyclopedia, Family Library, 
Cabinet Library, &e. 
This Atlas comprises, in a volume of the Family Library 
size, nearly 100 Maps and Tallies, which presenl equal 
1 to Fifty Thousand Names of Places ; a body of informa- 
tion three times as extensive as that supplied by the 
; generality of Quarto Atlases. 

Opinions of the Public Journals. 
1 "This beautiful and most useful little volume," says 
the Literary Gazette, " is a perfect picture of elegance, 
^obtaining a vast s i in of geographical information. A 
uore instructive little present, or a <. r ift better calculated 
iohe long preserved and often referred to, could not be 
offered to favored youth of either sex. Its cheapness, we 
must add, is another recommendation ; for, although this 
elegant publication contains lou beautiful engravings 
ir is issued at a price that can be no obstacle to its being 
procured by every parent and friend to youth." 

" This Atlas far surpasses any thing of the kind which 
Ne have seen, an.l is made to suit the popular libraries 
iwhich Dr. Lardner and Mr. .Murray are now sending into 
(every family in the empire " — Monthly Rccicw. 

" Its very ingenious method of arrangement secures to 
the geographical student the information for which hith- 
erto he has been obliged to resort to works of the largest 
dimensions." — Alhcnirum. 

•'This miniature and beautiful Atlas is likely to super- 
sede, for genera! purposes, maps of a more expensive and 
! elaborate character. It appears to us to answer the 
double purpose of exercising the attention while it im- 
prints all that is important in Geography on the memo- 
ry."— Atlas. 

w Tb ! workmanship is among the best of the kind we 
have ever wilnesse I." — Examiner. 

•' It contains all the information to be derived from the 
most expansive and unwieldy Atlas." — York Courant. 

li By a moment's reference, th > exact situation of any 
place may be found." — Birmingham Journal. 

" An excellent little work, engraved with a clearness 
and correctness which is quite surprising: when com- 
plete, travellers will have a system of Geography and a 
complete Atlas, winch they may carry i:i their pocket." — 

" This is the most perfect wm of an Atlas which has 
jver been published." — Bristol Journal. 

" It corresponds in size with those popular publications 
to which it will form so useful an addition— namely, 
The Family Library,' 'The Classical Library,' and 
'Cabinet Cyclopaedia." — Court Journal. 

■■ Nothing could be devised better calculated to impress 
upon the mind a knowledge of the general principles of 
Sography, than the plan of this publication." — The 
mtrder. 

■ It will be a crying shame in this age of intellect, if 
this able and beautiful work be not extensively patron- 
ized; but we cannot doubt the success which we feel 
assured its intrinsic merits must secure to it." — Intelli- 
gencer. 

" It is scarcely in the nature of things, that a work of 
so niueh public Gervice should fail in meeting with that 
extensive patronage which can alone remunerate the 
projectors." — Le$ds Intelligencer. 

"The plates are beautifully executed; and the geo- 
graphical student may obtain in this little work, such is 
the excellence of its arrangement, as much information 
as he could train by wading through several books of far 
<rreaT°r b ilk." — Weekly Dispatch. 

■• We have seldom seen a work so perfect in its arrange- 
ment, and so elegant in its execution." — York Courant. 

"For the accuracy of its delineation, and the extent 
of the information which it conveys, it stands without 
a rival in English topography." — Freeman's Journal. 

"The plan of this useful and elegant work may, in - 
deed, be called original. The style and execution of the 
Maps are of the first character." — Woolmer's Exeter and 
Plymouth Gazette. 

•'This work is one of the most useful publication 
which has yet issued from the press: it will be an unique 
and brilliant ace -ssion to the library, and a very useful 
work to the student in geography." — Reading Mercury 
and Oxford Gazette. 

" Its qualifications will render it one of the most popu- 
lar, highly interesting, and usefil publications of the 
dav." — L'verpool. Courier. 



MISCELLANEOUS. 



MEMOIRS of the LIFE of SIR WALTER 
RALEGH, with some account of the Period 
in which he lived. By Mrs. A. T. Thomson, 
With a portrait. 

"Such is the outline of a life, which, in Mrs. Thom- 
son's hands, is a mine of interest; from the first page 
to the last the attention is roused and sustained, atid 
while we approve ihe manner, we still more applaud 
the spirit in which it is executed." — Literary Gazelle. 

"In all respects a most appropriate volume for the 
Cabinet Library. We shall take an opportunity in 
anoiher notice, lo give some of the many interesting 
passages in the volume that oiler themselves for 
quotation." — N. Y. American. 

" Mrs. Thomson has written a very interesting book. 
It takes what we are inclined lo think, a just, and at 
the same time, lavorable view of Ralegh, and is oc- 
cupied beside with many entertaining and illustrative 
anecdotes." — Craftsman. 

" Presents in a concise but succinct style the variety 
of incidents connected with the life of the distinguish- 
ed subject of the memoir." — National Journal. 

"The book is unquestionably the best Liie of Ra- 
legh that has ever been written.'" — Album. 

" This is a piece of biography which combines the 
fascinations of romance with the deeper interest that 
attaches to historical narrative."' — Southern Patriot. 



ELEGANT LIBRARY EDITIONS 



OF TUE FOLLOWING WORKS. 



WORKS OF JOANNA BAILLIE. 

COMPLETE IN ONE VOLUME, 8vO. 

In the press. 



WORKS OF HENRY FIELDING. 

IN TWO VOLUMES 8vO., WITH A PORTRAIT. 



WORKS OF TOBIAS SMOLLETT. 

IN TWO VOLUMES 8vO., WITH A PORTRAIT. 

In the press. 



SELECT SPEECHES 

OF THE 

RIGHT HONORABLE GEORGE CANNING. 

EDITED BY ROBERT WAXSH, ESQ. 

WITH A BIOGRAPHICAL AND CRITICAL INTRODUCTION, 

BY TnE EDITOR. 

IN ONE VOLUME 8vO. 

In the press. 



SELECT SPEECHES 

OF THE 

RIGHT HONORABLE WILLIAM HUSKISSON, 

AND OF THE 

RIGHT HONORABLE WILLIAM WINDHAM. 

EDITED BY ROBERT WALSH, ESQ. 

WITH A BIOGRAPHICAL AND CRITICAL INTRODUCTION, 

BY THE EDITOR. 

IN ONE VOLUME 8vO. 

In the press. 



MEDICINE, SURGERY, &c. 



SURGICAL MEMOIRS of the CAM- 
PAIGNS of RUSSIA, GERMANY, and 
FRANCE. Translated from the French 
of Baron Larrey. In 8vo. with plates. 
A MANUAL of MEDICAL JURISPRU- 
DENCE, compiled from the best Medical 
and Legal Works; comprising an account 
of— I. The Ethics of the Medical Profes- 
sion; II. Charters and Laws relative to the 
Faculty; and III. All Medico-legal Ques- 
tions, with the latest Decisions: being an 
Analysis of a course of Lectures on Foren- 
sic Medicine. By Michael Ryan, M. D. 
Member of the Royal College of Physi- 
cians in London, &c. First American edi- 
tion, with additions, by R. Eglerfield 
Griffith, M. D. In 8vo. 
"There is not a fact of importance or value con- 
nected with the Science of which it treats, that is not 
to he found in its pages. The style is unambitious but 
clear and strong, and such as becomes a philosophic 
theme." — Montldy Review. 

"It is invaluable to Medical Practitioners, and mav 
be consulted safely by the Legal Profession."— Weekly 
Dispatch. . 

DIRECTIONS for MAKING ANATOM- 
ICAL PREPARATIONS, formed on the 
basis of Pole, Marjolin, and Breschet, and 
including the new method of Mr. Swan: by 
Usher Parsons, M. D. Professor of Anat- 
omy and Surgery. In 1 vol. 8vo. with plates. 
"It js compiled and prepared with judgment, and is 
the bes! and most economical companion the student 
can possess to aid him in the pursuit of this delightiul 
depar meat of his labors.'' — BosLMed. &■ Surg.Journ. 
SepL21, 1831. 

"This is unquestionably one of the most useful 
works on the preparation' of Anatomical Specimens 
ever published. It should be in the hands of every 
i6ver of Anatomy; and as attention now is more di- 
rected to the formation of museums, it will be found a 
very valuable book. JNothing is omitted that is im- 
portant, and many new formulae are introduced, de- 
rived from the author's experience, and from rare 
books, which he has had the industry to collect." — 
N. Y. Medical Journal, August, 1831. 

A PRACTICAL GUIDE to OPERATIONS 
on the TEETH, by James Snell, Dentist. 
In 8vo. with plates. 

PRINCIPLES of PHYSIOLOGICAL MED- 
ICINE, including Physiology, Pathology, 
and Therapeutics, in the form of Proposi- 
tions, and commentaries on those relating 
to Pathology, by F. J. V. Brolssais, &c. ; 
translated by Isaac Hays, M. D. and R. E. 
Griffith, M. D. In 8vo. 

ELEMENTS of PHYSIOLOGY, by Robley 
Dunglison. In 2 vols. 8vo. with numerous 
illustrations. (In the press.) 

PRINCIPLES of SURGERY, by John Syme, 
Professor of Surgery in the University of 
Edinburgh. In 8vo. 

PRACTICAL REMARKS on the NATURE 
and TREATMENT of FRACTURES of 
the TRUNK and EXTREMITIES; by 
Joseph Amesbury, Surgeon. In 8vo. with 
plates and wood-cuts. (In the press.) 



MISCELLANEOUS. 



GREEK and ENGLISH LEXICON. By D 

Donnegan. Abridged for the use of schools. 

In 1 vol. royal 18mo. containing nearly 600 

pages. 

This work is printing on a handsome distinct type, 
and will contain as much matter as many of the larger 
lexicons ; but owing to the form in which it is printed, 
will be sold at such price as to be within the reach 
of all students. It will offer more advantages to the 
young student than any other lexicon now in use. The 
vocabulary is more extensive and complete — compris- 
ing not only words found in the classics, but also such 
as are found in the writings of Hippocrates and the 
Greek Physicians. The meanings attached to words 
by the several writers are also given. 

Words are given in alphabetical order in every 
poetical and dialectic variety. 

The conjugation of verbs and flection of nouns are 
more complete than in other lexicons ; — the meanings 
of words fuller and more correct — there being first 
a primary and then a secondary meaning, each dis- 
tinguished from the metaphorcial and idiomaticai. 
Phrases are also given when they note any peculiarity 
in signification. The etymology of words is only 
omitted where it is confused or disputed. There is 
nothing left out which the young student would find 
necessary in studying the Classics, and which would 
enable him to understand the true meaning of a word. 
In short, in this work the essential advantages of a 
good Dictionary are combined with those of a good 
Grammar — advantages not found in any Greek and 
English lexicon now used. 

ELEMENTS of MECHANICS. By James 
Renwick, Esq. Professor of Natural and 
Experimental Philosophy, Columbia College, 
N. Y. In 8vo with numerous engravings. 

"We think this decidedly the best treatise on Me- 
chanics, which has issued from the American press, 
that we have seen ; one, too, that is alike creditable 
to the writer, and to tne state of science in this coun- 
try." — American Quarterly Review. 

TREATISE on CLOCK and WATCH-MA- 
KING, Theoretical and Practical, by 
Thomas Reid, Edinburgh Honorary Mem- 
ber of the Worshipful Company of Clock- 
Makers, London. Royal 8vo. Illustrated by 
numerous plates. 

MILLWRIGHT and MILLER'S GUIDE. 
By Oliver Evans. New Edition, with ad- 
ditions and corrections, by the Professor of 
Mechanics in the Franklin Institute of Penn- 
sylvania, and a description of an improved 
Merchant Flour-Mill, with engravings, by 
C. & O. Evans. 

GEOLOGICAL MANUAL. By H. T. De la 
Beche. In 8vo, with numerous wood-cuts. 

" A work of first-rate importance in the science to 
which it relates, and which must henceforth take its 
place in the library of every student in Geology." — 
Phil. Magazine. 

"Mr. De la Beche's Geological Manual is the first 
and best Work of the kind, and he has performed his 
task wiih a perfect knowledge of all that has been 
ascertained in Geology, and with considerable judg- 
ment and taste in the manner of doing it. So much 
geological science was never before compressed in so 
small a space." — Spectator. 



THE PEOPLE'S LIBRARY. 

" The editors and publishers should receive the thanks of the present generation, and the gratitude of 
osterity, for being the first to prepare in this language what deserves to be entitled not the ENCYCLO- 
*^ED1A AMERICANA, but the people's library." — N. Y. Courier and Enquirer. 

Just Published, by Carey <$f Lea, 

And sold in Philadelphia by E. L. Carey 4/ A. Hart ; in New- York by G. 4/ C. d> H. Carvill ; in Boston 

[y Carter $ Hendee ; in Baltimore by E. J. Coale, d> W. ty J. Neal ; in Washington by Thompson d/ Hermans ; 

W Richmond by J. H. Nash; in Savannah by W. T. Williams; in Charleston by W. H. Berrett; in New-Orleans 

fy W. MKean; in Mobile by Odiorne d> Smith ; and by the principal booksellers throughout the Union. 

VOLUME 9, -CONTAINING ABOUT l,50O ARTICLES, 

(To be continued at intervals of three months,) 

OF THE 

ENCYCLOPAEDIA AMERICANA: 

A 

POPULAR DICTIONARY 

OF 

ARTS, SCIENCES, LITERATURE, HISTORY, AND POLITICS, 

BROUGHT DOWN TO THE PRESENT TIME, AND INCLUDING A COPIOUS COLLECTION OF ORIGINAL ARTICLES IN 

AxMERICAN BIOGRAPHY: 

On the basis of the Seventh Edition of the German 

COjS YERSATIONS-LEXICON. 



Edited by FRANCIS LIEBER, 

ASSISTED BY 

EDWARD WIGGLESWORTH and T. G. BRADFORD, Esqrs. 



IN TWELVE LARGE VOLUMES, OCTAVO, PRICE TO SUBSCRIBERS, BOUND IN CLOTH, 
TWO DOLLARS AND A HALF EACH. 
EACH VOLUME CONTAINS BETWEEN 600 AND 700 PAGES. 



"THE WORLD-RENOWNED CONVERSATIONS- 
<EXICON."— Edinburgh Review. 

"To supersede cumbrous Encyclopaedias, and put within 
lie reach of the poorest man, a complete library, equal to 
bout fort_v or fifty good-sized octavos, embracing every 
ossible subject of interest to the number of 20, i 00 in all — 
rovided he can spare either from his earnings or his ex- 
ravagancies, twenty cents a week, for three years, a library 
o contrived, as to be equally suited to the learned and 
he unlearned,— the mechanic— the merchant, and the pro- 
sssional man." — JV*. Y. Courier and Inquirer. 

" The reputation of this valuable work has augmented 
vith each volume; and if the unanimous opinion of the 
iress, uttered from all quarters, be true, which in this 
nstance happens to be the case, it is indeed one of the 
iest of public 'tions. It should be in the possession of 
very intelligent man, as it is a library in itself, compris- 
mr an immense mass of lore upon almost every possible 
ubject, and in the cheapest possible form."— N. Y. J\Iirror. 

"Witnesses from every part of the country concurred 
n declaring that the Encyclopedia American a was in a 
air way to degrade the dignity of learning, and especially 
he learning of Encyclopedias, by making it too cheap- 
hat the multitudes of all classes were infatuated with it 
n saying in so many words from the highest to the low- 
st, ' the more we see of the work the better we like it.' " 
-JV". Y. Courier and Inquirer. 

" The articles in the present volume appear to us to 
•vince the same ability and research which gained so 
avorabie a reception for the work at its commencement, 
["he Appendix to the volume now before us. containing an 
iccount of the Indian Languages of America, must prove 
richly interesting to the reader in this country; and it is 
itonce remarkable as a specimen of history and philology, 
rhe work altogether, we may again be permitted to ob- 
serve, reflects distinguished credit upon the literary and 
scientific character,^ well as the scholarship of our 
toun try."— Charleston Courier. 

"The copious information which this work affords on 
American subjects, fully justifies its title of an American 
Dictionary; while at the same time the extent, variety, 
ind felicitous disposition of its topics, make it the most 
convenient and satisfactory Encyclopaedia that we have 
2ver seen." — National Journal. 

"If the succeeding volumes shall equal in merit the 
one before us, we may confidently anticipate for the work 
a reputation and usefulness which ought to secure for it 
the most flattering encouragement and patronage."— Fed- 
eral Gazette. 

" A compendious library, and invaluable book of refer- 
ence." — JV. Y American. 



" The variety of topics is of course vast, and they are 
treated in a manner which is at once so full of informa- 
tion and so interesting, that the work, instead of being 
merely referred to, might be regularly perused with as 
much pleasure as profit." — Baltimore American. 

" We view it as a publication worthy of the age and of 
the country, and cannot but believe the discrimination of 
our countrymen will sustain the publishers, and well re- 
ward them for this contribution to American Literature." 
— Baltimore Patriot. 

" It reflects the greatest credit on those who have been 
concerned in its production, and promises, in a variety of 
respects, to be the best as well as the most compendious 
dictionary of the arts, sciences, history, politics, biogra- 
phy, &c. which has yet been compiled." The style of the 
portion we have read is terse and perspicuous; and it is 
really curious how so much scientific and other informa- 
tion could have been so satisfactorily communicated in 
such brief limits." — JV. Y. Evening Post. 

"Those who can, by any honest modes of economy, 
reserve the sum of two dollars and fifty cents quarterly, 
from their family expenses, may pay for this work as fast 
as it is published ; and we confidently believe that they 
will find at the end that they never purchased so much 
general, practical, useful information at so cheap a rate." 
— Journal of Education. 

" If the encouragement to the publishers should corres- 
pond with the testimony in favor of their enterprise, and 
the beautiful and faithful style of its execution, the hazard 
of the undertaking, bold as it was, will be well compen- 
sated ; and our libraries will lie enriched by the most gene- 
rally useful encyclopedic dictionary that has been offered 
to the readers of the English language. Full enough for 
the general scholar, and plain enough for every capacity, 
it is far more convenient, in every view and form, than 
its more expensive and ponderous predecessors."— Ameri- 
can Farmer. 

"The high reputation of the contributors to this work, 
will not fail to insure it a favorable reception, and its 
own merits will do the rest." — Silliman's Journ. 

"The Encylopwdia Americana is a prodigious improve- 
ment upon all that has gone before it; a thing for our 
country, as well as the country that gave it birth, to be 
proud of; an inexhaustible treasury of useful, pleasant, 
and familiar learni ng on every possible6ubject. so arranged 
as to be speedily and safely referred to on emergency, as 
well as on deliberate inquiry; and better still, adapted to 
the understanding, and put within the reach of the mul- 
titude. * * * The Encyclopaedia Americana is a work 
without which no library worthy of the name can here- 
after be made up." — Yankee. 



ENCYCLOPEDIA AMERICANA. 

"The work will be a valuable possession to erery family | More than half of the volumes of this work ar 
or individual that can afford to purchase it ; and we take i now before the public, and the reception they hav 
pleasure, therefore, in extending the knowledge of its met with is the best evidence that the publishers hav 
menu. -National Intelhgencer. fulfilled the promises made at its outset. They hav 

"This work appears to improve as it issues from the now onlv to promise, for the editors and themselvei 
press. The number of able writers, who contribute ori- ■ lhat no exertion shall be spared to render the remair 

1^ S^^ in ? volumes equal to those already published, an, 

ence is amplv *imf i< rit to ^ive it relcbrity and nigh char- ,.° . .u . » •. • • j m L 

the active pursuits of life- thus susU,ni , ,he reputation it has acquired. The sut 

— this p.. pillar dictionary is a most scnption ■ large, and increasing ; and in those quai 

valuable and ready • nee. It embraces brief ters where its circulation is greatest, and where it i 

views a .i-coveries in science— best known, there is a constantly increasing demand 

and the present condition of liu ralure, politics, tc dec. , The publishers invite the attention of those who ma< 

room-efwy lawyer's library not ;i i r , .„; have po^seed themselves of it, or ma"' 

~ s5ar"*H- **• Ld ttn u r?,r * becorae a, rr l « 

with its merits, to the following account of the on 

"From the specimen which has already been *iven. we gina] work, upon which it is based, and which i 

have no hesitation in laying, that in recard to mielli termed by t!ie Edinburgh Review— 
Bkill. and faithful diligence, it is a work of the reft 

-iinlar publication that THE world-llnowned Leipzig conversations- 

can bear any comparison with it got the rich variety of lexicon. 

\a!nabli' inforuKitin. which it condenses within bo small T . , ■ . ■ , , 

- r f English , If "" intended to supply a want occasioned bj 

v iaiparual and interesting the character of the age, in which the sciences, arte 

ljnslish proiactioa, ami trades, and the \:trmu3 forms of knowledge and of 

I l>> none but German active life, had become so much extended and di- 

rwlmawereeattjoyi vidual engaged in business coulc 

-BnttmOmoontr. becom tinted with a I genera, 

valuable addition to the lite intent! ; while the wide diffusion of information ren- 

issr. dered such k;e • • ntial to the character of 

rk has had in Europe, "» accomplished man. This want, no existing works 

It* Ian were adequate to supply. Books treating of particulai 

kmm Genua editioas, bra ■. c. were too confined 

listed, ■peaks loudly in in character; while voluminous Encyclopaedias were 

itad » celebrity too ] earne d t scientific, and cumbrous, beimr usuaflj 

TUm r> H man 7^ elabora « quiring much study or , 

in public busi and ample book ' , «? „ ,. J , rf, 

and letters, the acquaintance 9 ed. I he r oil- 

man ill be almost invaluable. T rsation Lexicon endeavored- 

individi tioai wtere looks are: to select from every branch of knowledge what was 

neither numen tred, the rich contents m , • , Ibrmed mind, and to give popu- 

oune which will |ar views of the more abttruse branches of learning 

v ,th difficulty exhaust- 1 aml Ff . ie ncc ; that their readers mieht not be ir.com- 

ed; and we recommend it to their in the full .„_ 1 ,.,i „„.i ,i„ T ., ; ,.^ „ f ~u»„,.,„ ,.,."', m .,,,«-„m, 1 „t k„ 

1 colt to ?ay to 

what class of readers such a bo->k would not prove useful. 

nay. aim it combines a great 

table matter in small compass, and at 

se, and is in every respect well suited to 

ttoek o\ ideas, and powers of con- 

I .. without severely taxing time or fatiguing 

ritser. 



and deprived of pleasure or improvement, by 
ignorance of facts or expressions used in books or con- 
versation. Such a work must obviously be of greal. 
utility to i of readers. It has been found 

so much so in Germany, that it is met with every- 
where, among the learned, the lawyers, the military, 
artists, merchants, mechanics, and men of all stations. 
The reader may judge how well it i6 adapted to its 
from the circumstance, that though it now 
[twelve volumes, seven editions, com prising 
about one hundred thocsand cohes, have been 
tinted in less than fifteen years. It has been transr 
ated into the Swedish. Danish and Dutch languagjpl 
and a French translation is now preparing in Pans. 
In the preparation of the American edition, no 



f American Biojrraphy. a subject of 
ant. to the de- 
I many arc. is, in tl. 3 i oinent feature, 

and has receive! the attention Of one of the most inde- 
fatigable writers in this department of literature, which ; P 
ruish." — Bostoi Courier. 12 

"According to tii^ plan of Dr. Lieber, a desideratum 
will be supplied: the substance of contemporarv know- 
ledge « ill te brouc; til compass ;-and the P* ?V**ed to secure the ablest assistan 
character and uses : irted to a and the editors have been aided by many gentlemen 
kind of pub! cation heretofore reserved, on stroag shelve*, of distinguished ability. 

f>r occasional reference. By those who understand the. The American Biographf, which is very extensive^ 
German language, tlbs Conversation Lniron is consulted has been furnis ' "Walsh, who has long pail 

ten times for one application to any English Lncyclope- particular attention to that branch of our literature, 
dia. -National Gazette. | flnd from marerials „, the collection of which he has 

• The volume now published is not only highly honor- , been engaged for some vears. For obvious reasons, 
able to the taste, ability, and industry of its editors and, the notices i shed Americans are con- 

publishers, but furnishes a proud sample of the accuracy | f;iied l0 deeeaaed individuals: the European biogra- 



ab ° ra 5is a hedin o°ur i P h >' contains notKes of a!l distinguished' Uving cha 
:c!itors have thus acters - w ie °' P»* Umes 



tant literary enterprises may now be accomf 



far completed their task, it is impossible, in the course of j The articles on Zoology and the various branches 
a brief newspaper article, to speak with adequate justice. " of Natural .Science, and those on Chemistry and 
—Boston Bulletin. ', Mineralogy, have been prepared expressly for this 

" It continues to be particularly rich in the depart- work by gentlemen distinguished in the several de- 
ments of Bi'.graphy and Natural History. When we look ' partments. 

at the large mass of miscellaneous knowledge spread j In relation to the Fine Arts, the work is exceedingly 
before the reader, in a form which has never been equalled '. fl ch. Great attention was given to this in the German 
for its condensation, and conveyed in a style that cannot work anu .; )P Editors have been anxious to render it, 
be surpassed tor propriety and perspicuity, we cannot but ; . u rtf ,., p ,,. in . „ f u: riftn , „„ nprfrpt »<, possible 
think that the American Encyclopedia deserves a place in \ b U"' e nec-essarj a tdnions, as oerlect as ! ^' e - 
every collection, in which works of reference form a por- ! ,. To gentlenien of the Bar, the work will be pecu- 
Mour—Soui.'iem Patriot. j harly valuable, as in cases where legal subjects are 

.. r. e ,u u . , ,. ^ L - j ^ , treated, an account is given of English, French, Gw- 

" By far the best work of the kind erer offered for sale „„ r> o , . T ,„„^„„ t „,.- 
in this country."-//. & Ga-.. raan and American Law. 



CABINET CYCLOPJEDIA, 

CONDUCTED BY THE 

REV. DIONYSIUS LARDNER, LL. D. F.R.S. L.&E. 

M.R.I. A. F.L.S. F.Z.S. Hon. P. C. PS. M. Ast. S. &c. &c. 

ASSISTED BY 

EMINENT LITERARY AND SCIENTIFIC MEN. 

Now publishing by Carey and Lea, and for sale by all Booksellers. 



This work will form a popular compendium of what 
rer is useful, instructive, and interesting, in the circle of 
mnan knowledge. A novel plan of publication and ar- 
kngement has been adopted, which presents peculiar 

pvantages. Without fully detailing the method, a few of 

«ese advantages may be mentioned. 

!| Each volume will contain one or more subjects uninter- 

riupted and unbroken, and will be accompanied by the 
torresponding plates or other appropriate illustrations, 
lacility of reference will be obtained without fettering 
lie work by a continued alphabetical arrangement. A 
ibscriber may omit particular volumes or sets of vol- 
mes, without disintegrating his series. Thus each pur- 
jiaser may form from the ''Cabinet" a Cyclopaedia, more 
; ' less comprehensive, as may suit his means, taste, or 
profession. If a subscriber desire to discontinue the work 
h|1 any stage of its publication, the volumes which he 
[lay have received will not lose their value by separation 
iom the rest of the work, since they will always either 
I complete in themselves, or may be made so at a trifling 
kpense. 

JThe purchasers will never find their property in this 
"rork destroyed by the publication of a second edition, 
(he arrangement is such that particular volumes may 

!! re-edited or re written without disturbing the others, 
he " Cabinet Cyclopaedia " will thus be in a state of 
mtinual renovation, keeping pace with the never-ceas- 
pg improvements in knowledge, drawing within its 
rcle from year to year whatever is new, and casting off 
rhatever is obsolete, so as to form a constantly modem- 
fed Cyclopaedia. Such are a few of the advantages which 
ijie proprietors have to offer to the public, and which they 
edge themselves to realize. 

Treatises on subjects which are technical and profes- 
onal will be adapted, not so much to those who desire 
attain a practical proficiency, as to those who seek 
at portion of information respecting such matters which 
generally expected from well-educated persons. An 
terest will be imparted to what is abstract by copious 
lustrations, and the sciences will be rendered attractive, 
\ treating them with reference to the most familiar ob- 
cts and occurrences, 

The unwieldly bulk of Encyclopaedias, not less than 
le abstruse discussions which they contain, has hitherto 
pnsigned them to the library, as works of only occasional 
ifirerice. The present work, from its portable form and 
'lopular style, will claim a place in the drawing-room and 
|e boudoir. Forming in itself a Complete Library, af- 
prdftig an extensive and infinitely varied store of in- 
iruction and amusement, presenting just so much on 
[very subject as those not professionally engaged in it 
squire, convenient in size, attractive in form, elegant in 
Lustrations, and most moderate in expense, the "Cabinet 
Iyclop/edia" will, it is hoped, be found an object of para- 
lount interest in every family. 

To the heads of schools and all places of public educa- 
ion the proprietors trust that this work will particularly 
JcOmmend itself. 

It seems scarcely necessary to add, that nothing will 
e admitted into the pages of the " Cabinet Cyclopaedia" 
Sniich can have the most remote tendency to offend public 
r private morals. To enforce the cultivation of religion 
nd the practice of virtue should be a principal object 
nth all who undertake to inform the public mind ; but 
[Vith the views just explained, the conductor of this work 
?els these considerations more especially pressed upon 
lis attention Parents and guardians may, therefore, 
(est assured that they will never find it necessary to place 
i volume of the " Cabinet " beyond the reach of their chil- 
ren or pupils. 



Considerable progress having been made in this 
;k'ork, the publishers wish to direct the attention of 
!,he public to the advantages by which it is distin- 
guished from other similar monthly publications. 
It is not intended that the Cabinet Cyclopaedia shall 
rm an interminable series, in which any work of 



interest which may present itself from time to time 
can claim a place. Its subjects are classified accord- 
ing to the usual divisions of literature, science, and 
art. Each division is distinctly traced out, and will 
consist of a determinate number of volumes. Al- 
though the precise extent of the work cannot be fixed 
with certainty, yet there is a limit which will not be 
exceeded ; and the subscribers may look forward to 
the possession, within a reasonable time, of a complete 
library of instruction, amusement,, and general refer- 
ence, in the regular form of a popular Cyclopaedia. 

The several classes of the work are — 1, NATURAL 
PHILOSOPHY; 2, The USEFUL and FINE ARTS; 
3, NATURAL HISTORY; 4, GEOGRAPHY; 5, 
POLITICS and MORALS ; 6, GENERAL LITE- 
RATURE and CRITICISM ; 7, HISTORY ; 8, BI- 
OGRAPHY. 

In the above abstruse and technical departments 
of knowledge, an attempt has been made to convey 
to the reader a general acquaintance with these sub- 
jects, by the use of plain and familiar language, ap- 
propriate and well-executed engravings, and copious 
examples and illustrations, taken from objects and 
events with which every one is acquainted. 

The proprietors formerly pledged themselves that 
no exertion should be spared to obtain the support of 
the most distinguished talent of the age. They trust 
that they have redeemed that pledge. Among the 
volumes already published in the literary department, 
no less than four have been the production of men 
who stand in the first rank of literary talent,: — Sir 
James Mackintosh and Sir Walter Scott. In the sci- 
entific department, a work has been produced from 
the pen of Mr. Herschel, which has been pronounced 
by the highest living authority on subjects of general 
philosophy, to contain " the noblest observations on 
the value of knowledge which have been made since 
Bacon," and to be " the finest work of philosophical 
genius which this age has seen." 

The following is a selection from the lift of Contributors. 

The Right Honorable Sir JAMES MACKIN- 
TOSH, M. P. 

The Right Rev. The Lord Bishop of Cloyne. 

Sir WALTER SCOTT, Bart. 

JOHN FREDERICK WILLIAM HERSCHEL, 
Esq. 

THOMAS MOORE, Esq. 

J. B. BiOT, Member of the French Institute. 

ROBERT SOUTHEY, Esq. Poet Laureate. 

The Baron CHARLES DUPIN, Member of the 
Royal Institute and Chamber of Deputies. 

THOMAS CAMPBELL, Esq. 

T. B. MACAULEY, Esq. M. P. 

DAVID BREWSTER, LL.D. 

J. C. L. SISMONDI, of Geneva. 

Capt. HENRY KATER, Vice President of the 
Royal Society. 

The ASTRONOMER ROYAL. 

DA VIES GILBERT, Esq. M. P. 

S. T. COLERIDGE, Esq. 

JAMES MONTGOMERY, Esq. 

The Right Hon. T. P. COURTENAY, M.P. 

J. J. BERZELIUS, of Stockholm, F. R. S., &c. 

The Rev. G. R~ GLEIG. 

T. PHILLIPS, Esq. Prof, of Painting, R. A. 

Rev. C. THIRLWALL, Fellow of Trinity College, 
Cambridge. 

ANDREW URE, M.D. F.R.S., &c. &c. &c. 



DR. LARDNER'S 
CABINET CYCLOPEDIA. 



VOLUMES PUBLISHED. 

I. II— HISTORY of SCOTLAND. By Sir Walter 
Scott. 

in. VI.— HISTORY of ENGLAND. By Sir James 

• Mackintosh. In 8 Vols. Vols. I. and II. 

IV.— OUTLINES of HISTORY. 

V— HISTORY of the NETHERLANDS. By T. C. 
Grattan, Esq. 

VII. VIII. XII— HISTORY of FRANCE. By Eyre 
Evans Crowe. In 3 Vols. 

IX.— MECHANICS. By Capt. Kater and Dr. 
Lardner. 

X— A PRELIMINARY DISCOURSE on the OB- 
JECTS, ADVANTAGES, and PLEASURES of 
the STUDY of NATURAL PHILOSOPHY. In 
1 Vol. By J. F. W. Herschel, Esq. 

XI— BIOGRAPHY of EMINENT BRITISH 
STATESMEN. 

XIII— HYDROSTATICS and PNEUMATICS. By 
Dr. Lardner. 

XIV— HISTORY of the PROGRESS and PRE- 
SENT SITUATION of the SILK MANUFAC- 
TURE. 

XV— HISTORY of the ITALIAN REPUBLICS. 
By J. C. L Sismondi. 

XVI. XVII. XVIII.— HISTORY of MARITIME 
and INLAND DISCOVERY. In 3 vols. 



VOLUMES EV IMMEDIATE PREPARA- 
TION. 

HISTORY of ENGLAND. Vol. III. 

HISTORY of the PROGRESS and PRESENT 
STATE of the IRON MANUFACTURE. 

LIVES of EMINENT BRITISH LAWYERS. In 
1 Vol. By H. Roscoe, Esq. 

The HISTORY of the WESTERN WORLD. In 

4 Vols. Vol. I. The UNITED STATES of AMER- 
ICA. 

Two volumes of this work, nearly ready, will 
complete the History of the United States to the 
present time. The two remaining volumes will 
be devoted to South America and the West India 
Islands. 

A HISTORY of IRELAND, to the UNION. In 2 
Vols. By T. Moore, Esq. 

A PRELIMINARY DISCOURSE on the USEFUL 
ARTS and MANUFACTURES. By the Baron 
Charles Dufin, Member of the Institute of France 
and of the Chamber of Deputies. 

A HISTORY of the MOORS. In 3 Vols. By Rob- 
ert Southey, Esq. 

LIVES of the MOST EMINENT LITERARY 
MEN of ALL NATIONS. In 8 Vols. By Scott, 
Southey, Moore, Mackintosh, Montgomery, 
Cunningham, and all the principal Literary and 
Scientific Contributors to the Cyclopaedia. 

A TREATISE on ASTRONOMY. By J. F. W. 
Herschel, Esq. 

GEOGRAPHY. In 4 Vols. By W. Cooley, Esq. 
author of the " History of Maritime Discovery." 

LIVES of the MOST DISTINGUISHED BRITISH 
NAVAL COMMANDERS. By R. Southey, Esq. 

LIVES of the MOST DISTINGUISHED BRITISH 
MILITARY COMMANDERS. By the Rev. G. R 
Gleig. 

A TREATISE on OPTICS. By David Brew- 
ster. 

The HISTORY of GREECE. In 3 Vols. By the 
Rev. C. Thirlwall. 

LIVES of EMINENT BRITISH ARTISTS. By 
W. Y. Otley, Esq. and T. Phillips, R. A. Professor 
of Painting to the Roval Academy. 

A TREATISE on ELECTRICITY and MAGNET- 
ISM. By M. Biot, Member of the French Insti- 
tute. 



V books that you may carry to the fire, and holi 
readily in your hand, are the most useful aftef 
all. a man will often look at them, and be 
tempted to go on, when he would have bee^ 
frightened at books of a larger size, and of a 

MORE ERUDITE APPEARANCE." — Dr. Johnson. 

"We advisedly call the Cabinet Cyclopedia a great 
undertaking, because we consider, that in its effects or 
the tone and habits of thought of what is known by the 
phrase, ' the reading public,' it will be, if carried through 
in the spirit of its projection and commencement, one ov 
the most invaluable productions of modern literature. * *b 

"But these advantages, eminent as they undoubtedly 
are, are not the sole nor the chief recommendations ol 
the Cabinet Cyclopaedia. Neither is it on the extreme 
cheapness of the publication, nor the federal independence 
— if we may so speak — of its several volumes, that we 
rest our prediction of its influence on the tone of think- 
ing of the present, and on the literature of the next gen- 
eration—but on the promise, amounting almost to a moral 
certainty, of the great excellence of its execution. A mul- 
titude of persons eminent in literature and science in the 
United Kingdom are employed in this undertaking; and, 
indeed, no others should be employed in it ; for it is a truth, 
that the profound and practised writer alone is capable of; 
furnishing a ' popular compendium.' 

" What parent or guardian that throws his eye over the 
list of its contributors bat must be rejoiced by meeting 
the names of those who are in themselves a guarantee, 
of intellectual and moral excellence?" — Literary Gazette/. 

" The plan of the work appears well adapted to the pur- 
pose it is proposed to fulfil— that of supplying a series of 
publications, embracing the whole range of literature 1 
and science, in a popular and portable form; while the 
excellence of the execution is guarantied by the judgment 
displayed in the selection of writers. The list of authors 
employed in this ambitious undertaking comprises some 
of the most eminent men of the present age." — Atlas. 

" The Cyclopedia, when complete, will form a valuable 
work of reference, as well as a most entertaining and in- 
structive library. It is an essential principle in every part 
of it, that it should be clear and easily understood, and 
that an attempt should everywhere be made to unite 
accurate information with an agreeable manner of con-i 
veyingit. It is an experiment to try how much science | 
may be taught with little crabbed or technical language,' 
and how far the philosophical and poetical qualities of , 
history may be preserved in its more condensed state. It \ 
possesses also the most indispensable of all the qualities 
of a work intended for general instruction— that of cheap- 
ness. Whatever the plan might be, it was evident that j 
the grand difficulty of Dr. Lardner was to unite a body 
of writers in its execution, whose character or works af- j 
forded the most probable hope that they were fitted for a . 
task of which the peculiarity, the novelty, and even the 
prevalent relish for such writings greatly enhance the dif- 
ficulty. We do not believe, that in the list of contribu- 
tors, there is one name of which the enlightened part of 
the public would desire the exclusion. 

"In science, the list is not less promising. The names 
of the President, Vice-Presidents, and most distinguished 
Fellows of the Royal Society, are contained in it. A 
treatise on astronomy, by Herschel ; on optics, by Brews- 
ter; and on mechanics, by Lardner; need be only recom 
mended by the subjects and the writers. An eminent 
Prelate, of" the first rank in science, has undertaken a 
noble subject which happily combines philosophy with 
religion. Twelve of the most distinguished naturalists 
of the age, Fellows of the Linnaean and Zoological So 
cieties, are preparing a course of natural history. Others 
not less eminent in literature and science, whose names it 
is not needful yet to mention, have shown symptoms of an 
ambition to take a place among such fellow-laborers."— 
Times. 

" The topics, as may be supposed, are both judiciously 
selected and treated with ability. To general readers, 
and as part of a family library, the volumes already pub- 
lished possess great recommendations. For the external 
beauties of good printing and paper they merit equal com- 
mendation." — Bait. American. 

"The uniform neatness of these volumes, their very 
moderate price, and the quantity of information which 
they contain, drawn from the best and most attractive 
sources, have given them deserved celebrity, and no one 
who desires to possess such information, should hesitate 
a moment to add them to his library."— Fed. Gazette. 

"This excellent work continues to increase in public 
favor, and to receive fresh accessions of force to its corps 
of contributors."— Lit. Gazette. 



LARDNER S CABINET CYCLOPAEDIA 



*>T THE MANY WORKS WHICH HAVE BEEN LATELY PUB- 

IN IMITATION, OR O.N THE PLAN ADOPTED BY THE 

SOCIETY FOR THE D.FFUSION OF USEFUL. KNOWLEDGE, DR. 

IlaRDNER'S CYCLOPEDIA IS BY MUCH THE MOST VALUA- 
BLE, AND THE MOST RKCOMMENDED BY DISTINGUISHED 

| ASSISTANCE, SCIENTIFIC AND LITERARY." 

Edinburgh Review. 



History op England. By sir James 

: Mackintosh. In 8 Vols. Two "Vols, pub- 
! lishtd. 

j " In the first volume of Sir James Mackintosh's His- 
bry of England, we find enough to warrant the antici- 

Etions of the public, that a calm and luminous philoso- 
- will , infuse its If over the long narrative of our Brit- 
ih History. "— Edinburgh Review. 

In this volume Sir James Mackintosh fully developes 
liose great powers, for the possession of which the public 
ave lonsr given him credit. The result is the ablest com- 
jentary that has yet appeared in our language upon some 
f the most important circumstances of English History." 
-Atlas. 

" Worthy in the method, style, and reflections, of the 
uthor's high reputation. We were particularly pleased 
nth his high vein of philosophical sentiment, and his 
ccasional survey of con temporary annals."— National 
lazette 

" If talents of the highest order, long experience in po- 
tics. and years of application to the study of history 
nd the collection of information, can command superi- 
nty in a historian. Sir James Mackintosh may, without 
aiding this work, be said to have produced the best his- 

ry of this country. A perusal of the work will prove 
i.it those who anticipated a superior production, have 
nt reckoned in vain on the high qualifications of the 
uthor."— Courier. 

" Our anticipations of this volume were certainly very 
ighly raised, and unlike such anticipations in general, 
ley have not been disappointed. A philosophical spirit, 
nervous style, and a full knowledge of the subject, ac- 
lired by considerable research into the works of pre- 
diug chroniclers and historians, eminently distinguish 
ns popular abridgment, and cannot fail to recommend it 
> universal approbation. In continuing his work as he 
» begun. Sir JamM Mackintosh wil l ow rfw a great Dene- 
t on his country." — Lond. Lit. Gazette. 
"Of its general merits, and its permanent value, it is 
npossible to speak, without the highest commendation, 
nil after a careful and attentive perusal of the two vol 
mes which have been published, we are enabled to de- 
are that, so far, Sir James Mackintosh has performed 
le duty to which he was assigned, with all the ability 
iat was to be expected from his great previous attain- 
lents, his laborious industry in investigation, his exoel- 
nt judgment, his superior talents, and bis honorable 
rinciples " — Inquirer. 

• We shall probably extract the whole of his view of 
le reformation, merely to show how that important topic 
as been handled by ho able and philosophical a writer, 
rofessing Protestantism.— National Gazette. 

" The talents of Sir James Mackintosh are so justly and 
>eply respected, that a strong interest is necessarily ex- 
ited with regard to any work which such a distinguished 
■Titer may think fit to undertake. In the present instance, 
3 in all others, our expectations are fully gratified."— 
fentleman's Magazine. 

"The second volume of the History of England, form- 
ig the sixth of Carey & Lea's Cabinet Cyclopedia, has 
sen sent abroad, and entirely sustains the reputation of 
s predecessors. The various factions and dimensions, 
le important triais and battles, which render this period 
) conspicuous in the page of history, are all related with 
reat clearness and masterly power."— £oWoh Traveller. 



HISTORY OP SCOTLAND. By Sir Walter 
Scott. Iu H Vols. 

" The History of Scotland, by Sir Walter Scott, we do 
not hesitate to declare, will be, if possible, more exten- 
sively read, than the most popular work of fiction, by the 
same prolific author, and for this obvious reason : it com- 
bines much of the brilliant coloring of the Ivanhoe pic- 
tures of by-gone manners, and all the graceful facility of 
style and picturesqueness of description of his other 
charming romances, with a minute fidelity to the facts 
of history, and a searching scrutiny into their authenti- 
city and relative value, which might put to the blush 
Mr. Hume and other professed historians. Such is the 
magic charm of Sir Walter Scott's pen, it iias only to 
touch the simplest incident of every-day life, and it starts 
up invested with all the interest of a scene of romance ; 
and yet such is his fidelity to the text of nature, that the 
knights, and serfs, and collared fools with whom his in- 
ventive genius has peopled so many volumes, are regarded 
by us as not mere creations of fancy, but as real flesh and 
blood existences, with all the virtues, feelings and errors 
of common-place humanity." — Lit. Gazette. 



tlOGEAPHY OF BRITISH STATESMEN; 
containing the Lives of Sir Thomas More, 
Cardinal Wolsey, Archbishop Cranmer, 
and Lord Burleigh. 

" A vcrv delightful volume, and on a subject likely to 
lcrease in interest as it proceeds. * * * We cordially 
ommend the work both for its design and execution."— 
,ond. Lit Gazette 



HISTORY OP FRANCE. By Eyre Evans 
Crowe. In 3 vols. 

HISTORY OP PRANCE, from the Restora- 
tion of the Bourbons, to tlie Revolution 
of 1830. By T. B. Macanlay, Esq. M. P. 
Nearly ready. 

" The style is concise and clear; and events are sum- 
med up with much vigor and originality."— Lit. Gazette. 

" His history of France is worthy to figure with the 
works of his associates, the best of their day, Scott and 
Mackintosh." — Monthly Mag. 

" For such a task Mr. Crowe is eminently qualified. 
At a glance, as it were, his eye takes in the theatre of 
centuries. His style is neat," clear, and pithy; and his 
power of condensation enables him to say much, and 
effectively, in a few words, to present a distinct and 
perfect picture in a narrowly circumscribed space."— La 

Bella Assembler. 

"The style is neat and condensed; the thoughts and 
conclusions sound and just. The necessary conciseness 
of the narrative is unaccompanied by any baldness; on 
the contrary, it is spirited and engaging."— Bait. Ameri- 
can. 

"To compress the history of a great nation, during a 
period of thirteen hundred years, into three volumes, and 
to preserve sufficient distinctness as well as interest in 
the narrative, to enable and induce the reader to possess 
himself clearly of all the leading incidents, is a task l.y 
o means easily executed. It has, nevertheless, been well 
accomplished in this instance."— JV. Y. American. 

"Written with spirit and taste."— U- S. Gazette. 

"Could we but persuade our young friends to give 
these volumes a careful perusal, we should feel assured 
of their grateful acknowledgments of profit and pleas- 
ure."— JV. Y. Mirror. 

" At once concise and entertaining."— Saturday Bul- 
letin. 



THE HISTORY OP THE NETHERLANDS, 
to the Battle of Waterloo. By T. C. Grat- 

tan. 

" It is but justice to Mr. Crattan to say that he has 
executed his laborious task with much industry and pro- 
portionate Effect rjndiaflgpred by pompous nothingness, 
and without any ttt the affectation of philosophical pro- 
fundity. Ins style is simple, light, arid fresh— perspicuous, 
smooth, and harmonious."— La Belle Assemhlee. 

"Never did work appear at a more fortunate period. 
The volume before us is a compressed but clear and im- 
partial narrative '—Lit. Gaz, 

" A long residence in the country, and a ready access to 
libraries and archives, have furnished Mr Grattau with 
materials which he has arranged with skill, and out of 
which he has produced a most interesting volume."— 
Qent. M'tg. 



LARDNER'S 
CABINET CYCLOPAEDIA. 



" It is not east to devise a cure for sdch a state 
of things (the declining taste for science - ,) but 
the most obvious remedy is to provide the edu- 
cated classes with a series of works on popular 
and practical science, freed from mathematical 
symbols and technical terms, written in simple 
and perspicuous language, and illustrated by facts 
and experiments, which are level to the capacity 
OF ordinary minds." — Quarterly Review. 



CABINET OF 
AMERICAN HISTORY. 

BY T. P. GORDON. 



' 



PRELIMINARY DISCOURSE ON THE OB- 
JECTS, ADVANTAGES, AND PLEAS- 
URES OF THE STUDY OF NATURAL 
PHILOSOPHY. By J. T. W. Herschel, 
A. M. late Fellow of St. John's College, 
Cambridge. 

" Without disparaging any other of the many interest- 
ing and instructive volumes issued in the form of cabinet 
aifd family libraries, it is, perhaps, not too much to place 
at the head of the list, for extent and variety of condensed 
information, Mr. Herchel's discourse of Natural Philoso- 
phy in Dr. Lardner's Cyclopaedia." — Christian Observer. 

" The finest work of philosophical genius which this 
age has seen." — Mackintosh's England." 

" By far the most delightful book to which the existing 
competition between literary rivals of great talent and 
enterprise has given rise." — Monthly Review. 

" Mr. Herschel's delightful volume. * * * We find 
scattered through the work instances of vivid and happy 
illustration, where the fancy is usefully called into action, 
so as sometimes to remind us of the splendid pictures 
which crowd upon us in the style of Bacon."— Quarterly 
Review. 

"It is the most exciting volume of the kind we ever 
met with."— Monthly Magazine. 

"One of the most instructive and delightful books we 
have ever perused." — U. S. Journal. 



Volumes published. 

I. II. HISTORY of the SPANISH DISCOVER^ 
prior to the year 1520. 

To "be succeeded "by 

III. IV. V. HISTORY of ANAHUAC, or MEXIC 
from its discovery to the present time. In 3 vols 
VI. VII. HISTORY of PERU. In 2 vols. 
VIII. IX. HISTORY of BRAZIL. In 2 vols. &cd 



A TREATISE ON MECHANICS. By Capt. 
Kater, atnd tile Rev. Dionysias Lardncr. 
With numerous engravings. 

"A work which contains an uncommon amount of 
useful information, exhibited in a plain and very intelli- 
gible form."— Olmsted's Nat. Philosophy. 

"This volume has been lately published in England, as 
a part of Dr. Lardner's Cabinet Cyclopaedia, and has re- 
ceived the unsolicited approbation of the most eminent 
men of science, and the most discriminating journals and 
reviews, in the British metropolis. — It is written in a 
popular and in elligiblejstyle, entirely free from mathe- 
matical symbols, and disencumbered as far as possible of 
technical phrases." — Boston Traveller. 

" Admirable in development and clear in principles, and 
especially felicitous in illustration from familiar sub- 
jects." — Monthly Mag. 

"Though replete with philosophical information of the 
highest order in mechanics, adapted to ordinary capaci- 
ties in a way to render it at once intelligible and popu- 
lar."— Lit. Gazette. 

" A work of great merit, full of valuable information, 
not only to the practical mechanic, but to the man of sci- 
ence."— JV*. Y. Courier and Enquirer. 



A TREATISE ON HYDROSTATICS AND 
PNEUMATICS. By the Rev. D. Lardner. 
With numerous engravings. 

" It fully sustains the favorable opinion we have already 
expressed as to this valuable compendium of modern sci- 
ence."— Lit. Gazette. 

" Dr. Lardner has made a good uee of his acquaintance 
with the familiar facts which illustrate the principles of 
science." — Monthly Magazine. 

"It is written with a full knowledge of the subject, 
and in a popular style, abounding in practical illustra- 
tions of the abstruse operations of theie imporant sci- 
ences."— U. S. Journal 



Under this comprehensive title, it is pro 
publish a General History of America, divided in 
I parts making together a continuous whole ; yet eac 
naving an integral form, adapted for separate public' 
tion. Each portion will be brought down to tl 
period at which it shall be written, and will conta, 
a popular description of the geology, climate and pi 
ductions, and the civil history of the country to whk- 
: it relates. 

No work of this general nature has been publish* 
I in the English language. The work of Dr. Robertst- 
: is rather a philosophical essay on American histoid 
than an historical narrative ; and though original! 
designed to embrace the whole of the AmericE 
continent, it remains unfinished. It is written als 1: 
j with a bias unfavorable to America and its produ 
J tions, is incorrect in many important particulars, ar. 
is too much abstracted for popular use. 

This void in literature might have been properi 
filled by the writers of Spain, Portugal, France, f|. 1 
England, but has been supplied for Europe, in ',- 
measure, by an Italian, the Cavalier Campagnoni, L 
whose meritorious labor much use will be made J 
the proposed enterprise. 

The volumes herewith presented, may be deeme 
introductory to the w r hole work, since they narral 
the history of the discovery of the three great portior 
of America. In the prosecution of the subject, th 
existing political divisions will be pursued and coi 
nected with former ones, by proper explanations ; an 
where due regard for unity does not forbid, th 
chronological order will be preserved. Thus, th 
next succeeding part of the work, now advanced i 
preparation, will contain the history of Anahuac, < 
Mexico : including its ancient annals, an account c j 
us subjugation, and the policy of its conquerors, of i j 
late revolutions, and of its present constituent state ; 
In the same manner will be treated Central Americi j 
Peru, Chili, Bolivia, the United Provinces of La Piatt I 
Brazil and Colombia. Due attention will also be give 
to the independent Indian nations of South Americi j 
The history of the remainder of the country wi. 
be embraced by the following divisions : — 1. Russian.] 
2. British ; 3. Spanish ; 4. French ; 5. Danish ; 6. Dute j 
America; and 7, the United States and their depenc j 
encies. In treating the last division, a separate vo'j 
ume will be appropriated to each Stale and Territory]] 
the history of which may require it, and " The History 
of the United States " will be confined to the events <w 
the Revolution and the operations of the general gov 
ernment. 

A survey having been thus made of the whoftl 
Western Hemisphere, the concluding volume win 
contain the history of the Indian races, particular^, j 
those of the northern part of the continent, with l 
critical examination of the theories relaiing to thi 
original peopling of America. M 

The general title of the work is sufficiently com' 
prehensive to include a biography of distinguished j 
Americans, and others connected with American : 
history; and should the public support warrant it 
"An American Biography" may also be published j 
under it, in a cheap and popular form. 



CABINET LIBRARY. 



. 1.— NARRATIVE OF THE LATE 
[VAR IN GERMANY AND FRANCE. 

in- t!ie Marquess of Londonderry. With 
Map. 

2.— JOURNAL of a NATURALIST, 
Ivith plates. 

3w— AUTOBIOGRAPHY of SIR WAL- 
TER SCOTT. With a portrait. 

[ 4.— MEMOIRS of SIR WALTER RA- 
LEGH. By Mrs. A. T. Thomson. With a 

portrait. 

V 5.— LIFE of BELISARIUS. By Lord 
JlVIahox. 

. 6.— MILITARY MEMOIRS of the 
JDUKE of WELLINGTON. By Capt. 
3Ioyle Sherer. With a portrait. 

I. 7.— LETTERS to a YOUNG NATU- 
RALIST on the STUDY of NATURE 
and NATURAL THEOLOGY. By J. L. 

'(Drummond, M. D. With numerous en- 
gravings. 

IN PREPARATION. 

}FE of PETRARCH. By Thomas Moore. 

Leanings in natural history, 

•Ibein^ a Companion to the Journal of a Nat- 

jurali.st. 

f The Cabinet Library bids fair to be a series of great 
Rue, an 1 is recommended to public and private libraries, 
ional men, and miscellaneous readers generally. 
5s beautif.iik printed, and furnished at a price which 
01 plac.: it within the reach of all classes of society."— 
'\ierican Traveller. 

' |l The series of instructive, and, in their original form, 
nensive works, which these enterprising publishers are 
Sw issuing under the title of the "Cabinet Library," 

f fountain of useful, and almost universal knowledge; 
advantages of which, in forming the opinions, tastes 
1 manners of that portion of society, to which this 
pied information is yet new, cannot be too highly 
t i mated. '—National Journal. 

{['Messrs. Carey and Lea have commenced a series of 
plications under the above title, which an; to appear 
pathly, and which seem likely, from the specimen before 
, to acquire a high degree of popularity, and to afford 
imass of various information and rich entertainment, 
once eminently useful and strongly attractive. The 
khanical execution is fine, the paper and typography 
tcellent." — Nashville Banner. 



IEMOIRS OF THE LIFE OF SIR IV AL- 
JTER RALEGH, witli some Account of the 
IPeriod in which he lived. By MRS. A. T. 
[THOMSON. With a Portrait. 

i"Such is the outline of a life, which, in Mrs. Thorn - 
m's hands, is a mine of interest; from the first page to 
^e last the attention is roused and sustained, and while 
,e approve the manner, we still more applaud the spirit 
1 which it is executed." — Literary Gazette. 



JOURNAL OF A NATURALIST. With 
Plates. 

Plants, trees, and stones we note ; 

Birds, insects, beasts, and rural things. 

"We again most strongly recommend this little unpre- 
nding volume to the attention of every lover of nature, 



and more particularly of our country readers. It will 
induce them, we are sure, to examine more closely than 
thi'v have been accustomed to do, into the objects of ani- 
mated nature, and such examination will prove one of 
the most innocent, and the most satisfactory sources of 
gratification ami amusement. It is a book that ought 
to rind its way into every rural drawing-room in the 
king lorn, and one that may safely be placed in every 
lady's boudoir, be her rank and station in life what they 
may.'— Quarterly Review, No. LXXVIII. 

"We think that there are few readers who will not 
be delighted (we are certain all will be instructed) by the 
'Journal of a Naturalist.' "—Monthly Review. 

" This is a most delightful book on the most delightful 
of all studies. We are acquainted with no previous 
work which bears any resemblance to this, except 
'White's History of Selborne,' the most fascinating piece 
of rural writing and sound English philosophy that ever 
issued from the press." — Mhenaum. 

"The author of the volume now before us, has pro- 
duced one of the most charming volumes we remember 
to have seen for a long time." — New Monthly Magazine, 
June, 1829. 

"A delightful volume— perhaps the most so— nor less 
instructive and amusing— given to Natural History 
since White's Selborne."— Blackwood's Magazine. 

' " The Journal of a Naturalist, being the second num- 
ber of Carey and Lea's beautiful edition of the Cabinet 
Library, is the best treatise on subjects connected with 
this train of thought, that we have for a long time pe- 
rused, and we are not at all surprised that it should have 
received so high and flattering encomiums from the Eng- 
lish press generally."— Boston Traveller. 

"Furnishing an interesting and familiar account of 
the various objects of animated nature, but calculated 
to afford both instruction and entertainment."— Nash- 
ville Banner. 

" One of the most agreeable works of its kind in the 
language." — Courier de la L«uisiane. 

"It abounds with numerous and curious facts, pleas- 
ing illustrations of the secret operations and economy of 
nature, and satisfactory displays of the power, wisdom 
and goodness, of the great Creator." — Philad Album. 



THE MARQUESS OF LONDONDERRY'S 
NARRATIVE OF THE LATE WAR IN 
GERMANY AND FRANCE. With a Map. 

" No history of the events to which it relates can be 
correct without reference to its statements."— Literary 
Gazette. 

"The events detailed in this volume cannot fail to 
excite an intense interest." — Dublin Literary Gazette. 

"The only connected and well authenticated account 
we have of the spirit-stirring scenes which preceded the 
fall of Napoleon. It introduces us into the cabinets and 
presence of the allied inonarchs. We observe the secret 
policy of each individual : we sr-ee the course pursued by 
the wily Beruadotte, the temporizing Metternich, anil 
the ambitious Alexander. The work deserves a place in 
every historical library."— Globe. 

" We hail with pleasure the appearance of the first 
volume of the Cabinet Library." "The author had sin- 
gular facilities for obtaining the materials of his work, 
and he has introduced us to the movements and measures 
of cabinets which have hitherto been bidden from the 
world." — American Traveller. 

"It maybe regarded as the most authentic of all the 
publications which profess to detail the events of the 
important campaigns, terminating with that which se- 
cured the capture of the French metropolis."— Nat. Jour- 
nal. 

" It is in fact the only authentic account of the memo- 
rable events to which it refers."— Nashville Banner. 

" The work deserves a place in every library."— Phila- 
delphia Album. 



MISCELLANEOUS. 






A ME3IOIR OF SEBASTIAN CABOT, with 
a Review of tlie History of Maritime Dis- 
covery. Illustrated l>y Documents from 
the Rolls, now first published* 

•' Put forth in the most unpretending manner, and 
without a name, this work is of paramount importance 
to the subjects of which it treats." — Literary Gazette. 
"The author has corrected many grave errors, and in 
general given us a clearer insight into transactions of 
considerable national interest." — lb. " Will it not,'' says 
the author, with just astonishment, "be deemed almost 
incredible, that the very instrument in the Records of 
England, which recites the Great Discovery, and plainly 
contemplates a scheme of Colonization, should, up to 
this moment, have been treated by her own writers as 
that which first gave permission to go forth and explore ?" 
— lb. "We must return to investigate several collateral 
matters which we think deserving of more space than we 
can this week bestow. Meanwhile we recommend the 
work as one of great value and interest."— lb. 

" The general reader, as well as the navigator and the 
curious, will derive pleasure and informatfon from this 
well- written production.*'— Courier. 

"A specimen of honest inquiry. It is quite frightful to 
think of the number of the inaccuracies it expns.-s ; we 
shall cease to have confidence in books." 'The investi- 
gation of truth is not the fashion of these times. But 
every sincere inquirer after historical accuracy ought to 
purchase the book as a curiosity: more false assertions 
and inaccurate statements were never exposed in the 
same compass. Ii has given us a lesson we shall never 
forget, and hope to profit by."— Spectator. 



HISTORY OF THE NORTHMEN, OR XOR- 
MAXS AND DANES J from the earliest 
times to the Conquest of England "by 
William of Normandy. By Henry Whea- 
ton, Member of the Scandinavian and 
Icelandic JLiterary Societies of Copenha- 
gen. 

This work embraces the great leading features of Scan- 
dinavian history, commencing with the heroic age, and 
advancing from the earliest dawn of civilization to the 
introduction of Christianity into the North — its long and 
bloody strife with Paganism— the discovery and coloniza- 
tion of Iceland, Greenland, and North America, by the 
Norwegian navigators, before the time of Columbiis— the 
military and maritime expeditions of the Northmen — 
their early intercourse of commerce and war with Con- 
stantinople and the Eastern empire — the establishment 
of a Norman state in France, under Rollo. and the sub- 
jugation of England, first by the Danes, under Canute 
the Great, and subsequently by the Normans, under 
Duke William, the founder of the English monarchy. 
It also contains an account of the mythology and litera- 
ture of the ancient North— the Icelandic language pre- 
vailing all over the Scandinavian countries until the 
formation of the present living tongues of Sweden and 
Denmark — an analysis of the Eddas, Sagas, and various 
chronicles and songs relating to the Northern deities and i 
heroes, constituting the original materials from which 
the work has been principally composed. It is intended 
to illustrate the history of France and England during 
the middle ages, and at. the same time to serve as an 
introduction to the modern history of Denmark, Norway, 
and Sweden. 



"LETTERS TO A YOUNG NATURALIST, 
on the Study of Nature, and Natural The- 
ology. By JAMES "L. DRUMMOND, M. D. 
&c. "With nnmerous engravings. 

"We know of no work, compressed within the same 
limits, which seems so happily calculated to generate in 
a young mind, and to renovate in the old, an ardent love 
of nature in all her forms."— Monthly Review. 

"We cannot but eulogize, in the warmest manner, the 
endeavor, and we must say the successful endeavor, of a 
man of science, like Dr. Drummond, to bring down so 
exalted a pursuit to the level of youthful faculties, and to 
cultivate a taste at once so useful, virtuous, and refined." 
— New Monthly Mag. 



PRIVATE MEMOIRS of NAPOLEON BC 

NAP ARTE, from the French of M. Faitvi 

let de Bourrienne, Private Secretary t 

the Emperor. In 2 vols. 8vo. 

The peculiar advantages of position in regard t 

his present subject, solely enjoyed by M. de Bourr 

enne, his literary accomplishments and moral qual 

fications, have already obtained for these memoirs th 

first rank in contemporary and authentic history. I 

France, where they had been for years expected wit 

anxiety, and where, since the revolution, no wor 

connected with that period or its consequent evenl 

has created so great a sensation, the volumes of Bout 

rienne have, from the first, been accepted as the onl; 

trustworthy exhibition of the private life and politica 

principles "of Napoleon. 

"We know from the best political authority now liv 
ing in England, that the writer's accounts are perfect! 
corroborated by facts."— Lit. Gaz. 

ANNALS of the PENINSULAR CAM 
PAIGNS. By the Author of Cyril Thorn 
ton. In 3 vols. 12mo. with plates. 

The HISTORY OF LOUISIANA, particu 
larly of the Cession of that Colony to th( 
United States of North America ; with ar 
Introductory Essay on the Constitution an( 
Government of the United States, by M. di 
Marbois, Peer of France, translated frorr 
the French by an American Citizen. Ir 
1 vol. 8vo. 

The PERSIAN ADVENTURER. By the 
Author of the Kuzzilbash. In 2 vols. 12mo 

" It is full of glowing descriptions of Eastern life."— 
Courier. 

MORALS of PLEASURE, Illustrated by 
Stories designed for Young Persons, in I 
vol. 12mo. 

" The style of the stories is no less remarkable for its 
ease and gracefulness, than for the delicacy of its humor 
and its beautiful and at times affecting simplicity. A 
lady must have written it— for it is from the bosom of 
woman alone, that such tenderness of feeling and such 
delicacy of sentiment — such sweet lessons of morality- 
such deep and pure streams of virtue and piety, gush 
forth to cleanse the juvenile mind from the grosser impu- 
rities of our nature, and prepare the young for lives of 
usefulness here, and happiness hereafter."— J\T. Y. Com. 
Advertiser. . I 

CLARENCE; a Tale of our own Times. By 
the Author of Redwood, Hope Leslie, &c. 
In 2 vols. 

AMERICAN QUARTERLY REVIEW, pub- 
lished on the first of March, June, Septem- 
ber, and December. Price $5 per ann. 
*** A few complete Sets of the Work are still for 



CONSIDERATIONS ON THE CURREN- 
CY AND BANKING SYSTEM OF THE 
UNITED STATES. By Albert Galla- 
tin. 

SONGS of the AFFECTIONS. By Felicia 
Hemans. Royal 19 mo. 



J 



SCOTT, COOPER, AND 'WASHINGTON IRVING. 



) 



BY SIR WALTER SCOTT. 



'OUNT ROBERT OF PARIS, a Tale of 
the Lower Empire. By the Author of Wa- 
verley. In 3 vols. 

"The reader will at once perceive that the subject. 
ie characters and the scenes or action, could not have 
en betti r selected tor the display of the various and (in- 
itialled powers of the author. All that is glorious in arts 
id splendi 1 in arms— the glitter of armor, the pomp of 
ar. an I the splendor of chivalry— the gorgeous scenery 
f the Bosphorus— the ruins of Byzantium— the magnifi- 
•nce of the Grecian capital, and the richness and volup- 
lousness of the imperial court, will rise before the reader 
i a succession of beautiful and dazz.ing images." — Com- 
axial Advertiser. 

AUTOBIOGRAPHY OF SIR WALTER 
SCOTT. With a Portrait. 

M This is a delightful volume, which cannot fail to sati- 
sfy every reader, and of which the contents ought to be 
iuown to all those who would !>:• deemed conversant with 
line literature of our era."— National Gazette. 

tnSTORY OF SCOTLAND. In 2 vols. 

'• The History ofScotland, by Sir Walter Scott, we do 
cot hesitate to declare, will be, if possible, more exten- 
sively read, than the most popular work of fiction, bv the 
lame prolific author, and for this obvious reason: it com- 
plies much of the brilliant coloring of the Ivanhoe pic- 
\ ires of by-gone manners, and all the graceful facility of 
[ityle and picturesqueness of description of his other 
(harming romances, with a minute fidelity to the facts 
•pf history, and a searching scrutiny into their authenti- 
city and relative value, which might put to the blush 
Ulr. Hume and other professed historians, Such is the 
nagic charm of Sir Walter Scott's pen, it has only to 
I men the simplest incident of e very-day life, and it starts 
Up invested with all the interest of a "scene of romance; 
tnd yet such is his fidelity to the text of nature, that the 
t nights, and serfs, and collared fools with whom his in- 
| rentive genius has peopled so many volumes. ar« regarded 
by us as not mere creations of fancy, but as real flesh and 
Idood existences, with all the virtues, feelings and errors 
>f common -place humanity.'— Lit. Gazette. 

TALES of a GRANDFATHER, being a 
series from French History. By the Author 
of Waverley. 



BY MR. COOPER. 

|THE BRAVO. By the Author of the Spy, 
| Pilot, &c. In 2 vols. 

5The WATER-WITCH, or the SKIMMER 
of the SEAS. In 2 vols. 

| " We have no hesitation in classing this among the 
most powerful of the romances of our countryman."— 
\'U. Stales Gazette. 

| "We could out break from the volumes, and may pre- 
dict that they will excite the same interest in the minds 
of almost every reader. The concluding chapters produce 
intense emotion." — National Gazette. 

New Editions of the following Works by the 
same Author. 

[NOTIONS OF THE AMERICANS, by a 
Travelling Bachelor, 2 vols. 12mo. 

!The WEPT OF WISH-TON-WISH, 2 vols. 
12mo. 

| The RED ROVER, 2 vols. 12mo. 

| The SPY, 2 vols. 12mo. 

| The PIONEERS, 2 vols. 12mo. 

The PILOT, a Tale of the Sea, 2 vols. 12mo. 



LIONEL LINCOLN, or the LEAGUER of 
BOSTON, 2 vols. 

The LAST of the MOHICANS, 2 vols. 
12mo. 

The PRAIRIE, 2 vols. 12mo. 



BY WASHINGTON IRVING. 



VOYAGES and ADVENTURES of the 
COMPANIONS of COLUMBUS. By 
Washington Irving, Author of the Life 
of Columbus, &c. 1 vol. 8vo. 

"Of the main work we may repeat that it possesses 
the value of important history and the magnetism of ro- 
mantic adventure. It sustains in every tt spect the repu- 
tation of Irving." " We may hope that the gifted author 
will treat in like manner the enterprises and exploits of 
Pizarro and Cortes ; and thus complete a series of elegant 
recitals, which will contribute to the especial gratifica- 
tion of Americans, and form an imperishable fund of 
delightful instruction for all ages and countries."— jVat 
Gazette. 

"As he leads us from one savage tribe to another, as 
he paints successive scenes of heroism, perseverance and 
self-denial, as he wanders among the magnificent 
of nature, as he relates with scrupulous fidelity the 
errors, and the crimes, even of those whose lives are for 
the most part marked with traits to command admira- 
tion, and perhaps esteem — everywhere we find him the 
same undeviating, but beautiful moralist, gathering from 
every incident some lesson to present in striking lan- 
guage to the reason and the heart." — Am. Quarterly Re- 
view. 

"This is a delightful volume; for the preface truly says 
that the expeditions narrated and springing oe.t of the 
voyages of Columbus may be compared with attempts of 
adventurous knights-errant to achieve the enterprise left 
unfinished by some illustrious predecessors Washington 
living's name is a pledge how well their stories will be 
told: and we only regret that we must of necessity defer 
our extracts for a week."— London Lit. Gazette. 

A CHRONICLE of the CONQUEST of I 
GRENADA. By Washington Irving, 
Esq. In 2 vols. 

"On the whole, this work will sustain the hitrh fame 
of Washington Irving. It fills a blank in the historical 
library which ought not to have remained so long a 
blank. The language throughout is at once chaste and 
animated ; and the narrative may be said, like ;- 
Fairy Queen, to present one long gallery of splendid pic- 
tures." — Loud. Lit. Gazette. 

"Collecting his materials from various historians, and 
adopting in some degree Lhe tone and manner of a monk- 
ish chronicler, he has embodied them in a narrative which 
in manner reminds us of the rich and storied pages of 
Erroissart lie dwells on the feats of chivalry performed 
by tie- Christian Knights, with all the ardor which might 
led from a priest, who mixed, according to the 
usage of the times, not only in the palaces of courtly 
nobles, and their gay festivals, as an honored and wel- 
come guest, but who was their companion in the camp, 
and their spiritual and indeed bodily comforter and as- 
sistant in lhe field of battle.— Am. Quarterly Review. 

New Editions of the following Works by the 
same Author. 

The SKETCH BOOK, 2 vols. 12mo. 

KNICKERBOCKER'S HISTORY of NEW 
YORK, revised and corrected. 2 vols. 

BRACEBRIDGE HALL, or the HUMOR- 
ISTS, 2 vols. 12mo. 

TALES of a TRAVELLER, 2 vols. 12mo. 



TRAVELS, ANNUALS, &c. 



NOTES on ITALY, during the years 1S29-30. 
By Rembrandt Peale. In 1 vol. 8vo. 

"This artist will gratify all reasonable expectation; 
he is neither ostentatious, nor dogmatical, nor too mi- 
nute; he is not a partisan nor a carper; he admires with- 
out servility, he criticises without malevolence; his 
frankness and good humor give an agreeable color and 
effect to all his decisions, and the object of thein ; his book 
leaves a useful general idea of the names, works, and de 
serts. of the great masters; it is an instructive and enter- 
taining index." — Nat. Gaz. 

" We have made a copious extract in preceding columns 
from this interesting work of our countryman. Rembrandt 
Peale, recently published. It has received high commen- 
dation from respectable sources, which is justified by the 
portions we have seen extracted"— Commercial Advertiser. 

" Mr. Peale must be allowed the credit of candor and 
entire freedom from affectation in the judgments he has 
passed. At the same time, we should not omit to notice 
the variety, extent, and minuteness of his examinations. 
No church, gallery, or collection, was passed by, and most 
of the individual pictures are separately and carefully 
noticed." — Jim. Quarterly Review. 

FRAGMENTS of VOYAGES and TRAV- 
ELS, including ANECDOTES of NAVAL 

LIFE ; intended chiefly for the Use of Young 
Persons. By Basil Hall, Capt. R. N. In 

2 vols, royal 18mo. 

" His volumes consist of a melange of autobiography, 
naval anecdotes, and sketches of a somewhat discursive 
nature, which we have felt much pleasure in perusing." 

'The title page to these volumes indicates their being 
chiefly intended" for young persons, but we are much mis- 
taken if the race of gray-beards will lie among the least 
numerous of the readers of ' midshipmen's pranks and 
the humors of the green room.' " — Lit. Gazette. 

A TOUR in AMERICA. By Basil Hall, 

Capt. R. N. Ln 2 vols. 12mo. 

SKETCHES OF CHINA, with Illustrations 
from Original Drawings. By W. W. Wood. 
In 1 vol. 12mo. 

"The residence of the author in China, during the 
years ]?25-?-8 and 0, has enabled him to collect much 
very curious information relative to this singular people, 
which he has embodied in his work: and will serve to 
gratify the curiosity of many whose time or dispositions 
do not allow them to seek, in the voluminous writings of 
the Jesuits and early travellers, the information contained 
in the present work. The recent discussion relative to 
the renewal of the East India Company's Charter, has 
excited much interest; and among ourselves, the desire 
to be further acquainted with the subjects of 'the Celes- 
tial Empire,' has been considerably augmented." 

EXPEDITION to the SOURCES of the 
MISSISSIPPI, Executed by order of the 
Government of the United States. By Ma- 
jor S. H. Long. In 2 vols. 8vo. With Plates. 

HISTORICAL, CHRONOLOGICAL, GEO- 
GRAPHICAL, and STATISTICAL AT- 
LAS of NORTH and SOUTH AMERI- 
CA, and the WEST INDIES, with all 
their Divisions into States, Kingdoms, &c. 
on the Plan of Le Sage, and intended as a 
companion to Lavoisne's Atlas. In 1 vol. 
folio, containing 54 Maps. Third Edition, 
improved and enlarged. 



ATLANTIC SOUVENIR, FOR 1832. 

This volume is superbly bound in embossed 
leather, and ornamented with numerous plates, 
executed in the best style, by the first artists. 
No expense has been spared in the endeavor I 



to render it worthy of the purpose for which it 
is intended. 

Embellishments. — 1. The Hungarian Prin 
cess, engraved by Illman and Pillbrow, from a 
picture by Holmes. — 2. The Bower of Paphos, 
engraved by Ellis, from a picture by Martin. 
3. The Duchess and Sancho, engraved by Du- 
rand, from a picture by Leslie. — 4. Richard and 
Saladin, engraved by Ellis, from a picture by 
Cooper. — 5. The Rocky Mountains, engraved 
by Hatch and Smilie, from a picture by 
Doughty. — 6. Lord Byron in Early Youth, 
engraved by Ellis, from a picture by Saunders. 
— 7. Tiger Island, engraved by Neagle, from 
a picture by Stanfield. — 8. The Blacksmith, 
engraved by Kelly, from a picture by Neagle. 
— 9. The Tight Shoe, engraved by Kelly, from 
a picture by Richter. — 10. Isadore, engraved 
by Illman and Pillbrow, from a picture by 
Jackson. — 11. The Dutch Maiden, engraved 
by Neagle, from a picture by Newton. — 12. 
The Mother's Grave, engraved by Neagle, from 
a picture by Schaffer. 



I 



ATLANTIC SOUVENIR FOR 1831. 

Embellishments. — 1. Frontispiece. The 
Shipwrecked Family, engraved by Ellis, from 
a picture by Burnet. — 2. Shipwreck off Fort 
Rouge, Calais, engraved by Ellis, from a pic- 
ture by Stanfield. — 3. Infancy, engraved by 
Kelly, from a picture by Sir Thomas Law- 
rence. — 4. Lady Jane Grey, engraved by Kelly, 
from a picture by Leslie. — 5. Three Score and 
Ten, engraved by Kearny, from a picture by 
Burnet. — 6. The Hour of Rest, engraved by 
Kelly, from a picture by Burnet. — 7. The Min- 
strel, engraved by Ellis, from a picture by Les- 
lie. — 9. Arcadia, engraved by Kearny, from a 
picture by Cockerell. — 9. The Fisherman's 
Return, engraved by Neagle, from a picture 
by Collins. — 10. The Marchioness of Carmar- 
then, granddaughter of Charles Carroll of Car- 
rollton, engraved by Illman and Pillbrow, from 
a picture by Mrs. Mee. — 11. Morning among' 
the Hills, engraved by Hatch, from a picture 
by Doughty. — 12. Los Musicos, engraved by 
Ellis, from a picture by Watteau. 

A few copies of the ATLANTIC SOUVE- 
NIR, for 1830, are still for sale. 



THE BOOK of the SEASONS. By 
William Howitt. 

Since the publication of the Journal of a Naturalist, 
no work at once so interesting and instructive as the 
Book of the Seasons has been submitted to the public. 
Whether in reference to the utility of its design, or the 
grace and beauty of its execution, it will amply m n rit the 
popularity it is certain to obtain. It is, indeed, cheering 
and refreshing to meet with such a delightful volume, so 
full of nature and truth — in which reflection and experi- 
en :e derive aid from imagination— in which we are 
taught much ; but in such a "manner as to make it doubt- 
ful whether we have not been amusing ourselves all the 

me we have been reading."— New Monthly Magazine. 

" The Book of the Seasons is a delightful book, and 
recommended to all lovers of nature." — Blacktcood's Mag- 



EDUCATION. 



LESSONS on THINGS, intended to improve 
Children in the Practice of Observation, Re- 
flection and Description, on the System of 
Pestalozzi, edited by John Frost, A. M. 
The publishers request the attention of 
teachers, school committees, and all who are 
desirous of improving the methods of instruc- 
tion, to this work, which is on a plan hitherto 
unattempted by any school-book in this coun- 
trv. and which has been attended with extra- 
ordinary success in England. 

The following - remarks on the work are ex- 
tracted from the " Quarterly Journal of Edu- 
cation." 

" This little volume is a 'corrected and re-corrected' edi- 
tion of lessons actually given to children, and, therefore. 
possesses a value to which no hook made in the closet 
can lay claim, being the result of actual experiment. 
The work consists of a number of lessons, divided into 
live series; beginning with subjects the most easy and 
elementary, it gradually increases in difficulty, each suc- 
cessive stJp being adapted to the mind of the child as it 
acquires fresh stores of knowledge. 

- Every part of these lessons is interesting to the child, 
both on account of the active operation into which his 
own mind is necessarily called by the maimer in which 
the lessons are given ; and als.> by the attractive nature 
of many of the materials which form the subject of the 
lessons. In the first and most elementary series^ the pupil 
is simply taught to make a right use of his organs of 
sense, and to exercise his judgment so far only as relates 
to the objects about him; and accordingly the matter 
brought before him at this stage, is such that its obvious 
properties can be discovered and described by a child who 
has acquired a tolerable knowledge of his mother tongue." 

OUTLINES of HISTORY, from the Earliest 
Records to the Present Time. Prepared for 
the Use of Schools, with Questions, by John 
Frost, A. Bl 

" The main object of the work is, by giving a selection 
of interesting and striking facts from more elaborate his- 
tories, properly and carefully arranged, with chronological 
tables, to render the study of g -neral history leas dry and 
repulsive than it has been heretofore. This, we think is 
fullv accomplished. Very great car.; appears to have been 
bestowed on the selections, and in arranging the chrono- 
J logical tables, as well as in the classification of the his- 
torical matter into parts and chapters. The work will 
sufficiently recommend itself to all who examine it."'— 
Sat. Evening Post. 

"To concentrate in one comparatively small volume, a 
complete epitome of the entire history of the world, an- 
cient and modern, bo treated as to present a correct image 
of it. would seem to be an object for, rather 

than expected; the 'Outlines of History, 1 however, realize 
ject "—Asiatic Journal. 

"We consider thai Mr. F has done a service to schools, 
by the time and labor which h ■ has bestowed upon thi< 
work; the marginal dates will be found of greal 
but the chapters of questions upon the text, and upon the 
maps, to illustrate the geography of the history, will es- 
pecially recommend the work to the attention of teach- 
ers."— V. S. Gazette. 

Philadelphia, July liilh, 1831. 

"The 'Outlines of History ,' I consider an excellent 
class-book of general history for the use of schools. The 
questions added by Mr. Fr.TSt, are a most valuable auxili- 
ary for the teach r as "well a« the pupil. I shall use the 
'Outlines' in my school, and cordially recommend it to 
parents and teachers. S. C. WA DKEK." 

Philadelphia, April 30th, 1831. 

"Devk Sir,— Ihave just received a ropy of your edition 
of the -Outlines of History. 1 Fr.un a cursory perusal. I 
am disposed to give it a high rank as a school-book. So 
well satisfied am 1 with Hie arrangement and execution 
of the work, that I intend to pit it immediately into the 
hands of a class in my own school. 



TRENCH AND SPANISH. 



BY A. BOMIAR. 



A COLLECTION of COLLOQUIAL 
PHRASES on every Topic necessary to main- 
tain Conversation, arranged under different 
heads, with numerous remarks on the peculiar 
pronunciation and use of various words — the 
whole so disposed as considerably to facilitate 
the acquisition of a correct pronunciation of 
the French. By A. Bolmar. One vol. 18mo. 

A SELECTION of ONE HUNDRED 
PERRIN'S FABLES, accompanied by a Key, 
containing the text, a literal and free trans- 
lation, arranged in such a manner as to point 
out the difference between the French and the 
English idiom, also a figured pronunciation of 
the French, according to the best French works 
extant on the subject; the whole preceded by 
a short treatise on the sounds of the French 
language, compared with those of the English. 

Les AVENTURES de TELEMAQUE 

par FENELON, accompanied by a Key to 
the first eight books ; containing like the Fa- 
bles — the Text — a Literal — and Free Trans- 
lation ; intended as a Sequel to the Fables. 

The expression 'figured pronunciation,' is ahove em- 
ploned to express thai the words in the Key to the French 
Fables are sp It aid divided as they are pronounced. It is 
ir!iat WaLKBK has done in his Critical Pronouncing Dic- 
tionary ; for instance, he indicates the pronunciation of the 
word enough, by dividing and spelling it. thus, e-nuf. In 
the same maimer I indicate the pronunciation of the word 
comptaient thus, kon-te. As the understanding of the 
figured pronun iation of Walker requires the student to 
be acquainted iri'/i the primitive sounds of the English vow- 
eh, he must likewise, before he can understand the figured 
pronunciation of 'he French, make himself acquainted with 
the 20 primitive sounds of the French vowels. This any 
get from a native, or from anybody 
who reads French well, in a few hours. 

A COMPLETE TREATISE on the GEN- 
DERS of FRENCH NOUNS; in a small 
pamphlet of fourteen pages. 

This little work, which is the most complete 
of the kind, is the fruit of great labor, and will 
prove of immense service to every learner. 

ALL THE FRENCH VERBS, both REG- 
ULAR am) IRREGULAR, in a small volume. 

The verbs (ire 'o be, avoir to have, j/arler to Bpi afc, 
fmir to finish, recevoir to receive, vendee to sell.se 
lever to rise, se. bien porter to be well, s'en aller to go 
away, are here all conjugated through — affirmatively 
— negatively — ly — and negatively ami in- 

—an arrangeroeni which will greatly fa- 
cilitate the* scholar in his learning the French verbs, 
and which will save ibe master the trouble, of explain- 
ing o\<r and over again what may be much more 
!rne<! from books, thus leaving him more time 
to give bifl pu| il, doling the lesson, that instruction 
which cannot be found in books, but which must be 
learned from a rna 



Mr 



" Verv respectfully, your obedient servant, 
.John Frost." 'LEVI FLETCHER. 



NEUMANNS SPANISH and ENGLISH 

DICTIONARY. New Edition, in one vol. 
16mo. 



CLASSICAL LITERATURE. 



INTRODUCTION to the STUDY of the 
GREEK CLASSIC POETS, for the use of 
Young Persons at School or College. 

Contents. — General Introduction ; Ho- 
meric Questions ; Life of Homer; Iliad; 
Odyssey; Margites; Batrachomyornachia; 
Hymns ; Hesiod. By Henry Nelson Cole- 
ridge. 

" We have been highly pleased with this little volume. 
This work supplies a want which we have often painfully 
felt, and affords a manual which we should gladly see 
placed in the hands of every embryo under-graduate. 
We look forward to the next portion of this work with 
very eager and impatient expectation." — British Critic. 

" Mr. Coleridge's work not only deserves the praise of 
clear, eloquent and scholar like exposition of the prelimi- 
nary matter, which is necessary in order to understand 
and enter into the character of the great Poet of anti- 
quity; but it has likewise the more rare merit of being 
admirably adapted fur its acknowledged purpose. It is 
written in thai fresh and ardent spirit, which to the con- 
genial mind of youth, will convey instruction in the 
most effective manner, by awakening the desire of it; 
and by enlisting the lively and buoyant feelings in the 
cause of useful and improving study; while, by its preg- 
nant brevity, it is more likely to stimulate than to super- 
sede more profound and extensive research. If then, as it 
is avowedly intended for the use of the younger readers 
of Homer, and, as it is impossible not to discover, with a 
more particular view to the great school to which the au- 
thor owes his education, we shall be much mistaken if it 
does not become as popular as it will be useful in that 
celebrated establishment." — Quarterly Review. 

"We sincerely hope that Mr. Coleridge will favor us 
with a continuation of his work, which he promises." — 
Gent. Mag. 

" The author of this elegant volume has collected a vast 
mass of valuable information. To the higher classes of 

8" the public schools, and young men of universities, this 
volume will be especially valuable; as it will afford an 
agreeable reiief of light reading to more grave studies, at 
once instructive and entertaining."— Wesleyan Methodist 
Magazine. 

ATLAS OF ANCIENT GEOGRAPHY, con- 
sisting of 21 Colored Maps, with a complete 
Accentuated Index. By Samuel Butler, 
D. D., F. R. S. &c. Archdeacon of Derby. 

By the same Author. 

GEOGRAPHIA CLASSICA: a Sketch of 
Ancient Geography, for the Use of Schools. 
In 8vo. 

Extract of a Letter from Professor Stuart of 
Andover. 

" I have used Butler's Atlas Classica for 12 or 14 years, 
and prefer it on the score of convenience and correctness 
to any atlas within the compass of my knowledge. It 
is evidently a work of much care and taste, and most 
happily adapted to classical readers and indeed all others, 
who consult the history of past ages. I have long cherish- 
ed a strong desire to see the work brought forward in this 
country, and I am exceedingly gratified that you have 
carried through this undertaking. The beautiful manner] 
in which the specimen is executed that you have sent me| 
does great credit to engravers and publishers. It cannot) 
he that our schools and colleges will fail to adopt this I 
work, and bring it into very general circulation. I know 
of none which in all respects would supply its place." 

"The abridged but classical and excellent work of But- 
ler, on Ancient GeoL'iaphv, which you are printing as an 
accompaniment to the maps, I consider one of the most 
attractive works of the kind, especially for young persons 
studying the classics, that has come under my notice. I 
wish you the most ample success in these highly useful 
publications." 



MECHANICS, MANUFACTURES, &c. 



A PRACTICAL TREATISE on RAILf 5 
ROADS, and INTERIOR COMMUNl 
CATION in GENERAL— containing ai 
account of the performances of the differen; 
Locomotive Engines at, and subsequent tc 
the Liverpool Contest ; upwards of twj 
hundred and sixty Experiments with Table | 
of the comparative value of Canals and Rail 
roads, and the power of the present Locomo r 
tive Engines. By Nicholas Wood, Collier)' 
Viewer, Member of the Institution of Civfi 
Engineers, &c. 6vo. with plates. 

" In this, the able author has brought up his treatise tc 
the date of the latest improvements in this nationall)' 1 
important plan. We consider the volume to be one of 
great general interest. 1 '— Lit. Gaz. 

"We must, injustice, ref-r the reader to the work 1 
itself, strongly assuring him that, whether he be a man of: 
science, or one totally unacquainted with its technical. 
difficulties, he will here receive instruction and pleasure^ 
in a degree which we have seldom seen united before."—.. 
Monthly Rev. 

REPORTS on LOCOMOTIVE and FIXED 
ENGINES. By J. Stephenson and J^ 
Walker, Civil Engineers. With an Ac«t 
count of the Liverpool and Manchester Railii 
road, by H. Booth. In 8vo. with plates. 

MILLWRIGHT and MILLER'S GUIDEi 
By Oliver Evans. New Edition, with ad-j: 
ditions and corrections, by the Professor ofj; 
Mechanics in the Franklin Institute ofl : 
Pennsylvania, and a description of an ins 
proved Merchant Flour-Mill, with engrav J! 
ings, by C. & O. Evans, Engineers. 

THE NATURE and PROPERTIES of thW 
SUGAR CANE, with Practical Directions 
for its Culture, and the Manufacture of its 
various Products; detailing the improved. 
Methods of Extracting, Boiling, Refining,' 
and Distilling ; also Descriptions of the Best 
Machinery, and useful Directions for the> 
general Management of Estates. By George 
Richardson Porter. 

"This volume contains a valuable mass of scientific 
and practical information, and is, indeed, a compendium 
of everything interesting relative to colonial agriculture 
and manufacture." — Intelligencer. 

"We can altogether recommend this volume as a most 
valuable addition to the library of the home West India 
merchant, as well as that of the resident planter." — Lit. 
Gazette. 

"This work may be considered one of the most valua- 
ble books that has yet issued from the press connected 
with colonial interests; indeed, we know of no greater 
service we could render West India proprietors, than in 
recommending the study of Mr; Porter's volume."— Spec- 
tator. 

" The work before us contains such valuable, scientific, 
and practical information, that we have no doubt it will 
find a place in the library of every planter and person 
connected with our sugar colonies." — Monthly Magazine. 

A TREATISE on MECHANICS. By James 
Renwick, Esq. Professor of Natural and 
Experimental Philosophy, Columbia College, 
N. Y. In 8vo. with numerous engravings. 



crhemfatrg, JEatural ffifstorg, autr Piflcsoplig. 



THE CHEMISTRY OP THE ARTS, on the 
] basis of Gray's Operative Chemist, being 
3 an Exhibition of the Arts and Manufac- 
; tnrcs dependent on Chemical Principles, 
j with numerous En-ravines, l»y ARTHUR 
|m PORTER, M. D. late Professor of 
! Chemistry, &c. in the University of Vcr- 
I mont. In 8vo. With, numerous Plates. 
I 

j The popular and valuable English work of Mr. 
1 Gray, which forms the groundwork of the present 
J volume, was published in London in 1829, and de- 
signed to exhibit a systematic and practical view of the 
• numerous Arts and Manufactures which involve the 
•application of Chemical Science. The author himself, 
ja skilful, manufacturing, as well as an able, scientific 
chemist, enjoying the multiplied advantages afforded 
by the metropolis of the greatest manufacturing nation 
on earth, was eminently qualified lor so arduous an 
undertaking, and the popularity of the work in Eng- 
land, as well as its intrinsic merits, attest the fidelity 
and success with which it has been executed. In 
, ihe work now offered to the American public, the 
practical character of the Operative Chemist has been 
preserved, and much extended by the addition of a 
great variety of original matter, by numerous correc- 
tions of the original text, and the adaptation of the 
whole to the state and wants of the Arts and Manu- 
factures of the United States. Among the most con- 
siderable additions will be found full and extended 
treatises on the Bleaching of Cotton and Linen, on the 
various branches of Calico Printing, on the Manufac- 
ture of the Chloride of Lime, or Bleaching Powder, 
and numerous Staple Articles used in the Arts of 
Dying, Calico Printing, and various other processes 
of Manufacture, such as the Salts of Tin, Lead, Man- 
ganese, and Antimony; the most recent Improve- 
ments on the Manufacture of the Muriatic, Nitric, 
and Sulphuric Acids, the Chromates of Potash, the 
latest information on the comparative Value of Dif- 
ferent Varieties of Fuel, on the Construction of 
Stoves, Fire-Places, and Sloving Rooms, on the Ven- 
tilation of Apartments, &c. &c. The leading object 
has been to improve and extend the practical charac- 
ter of the Operative Chemist, and to supply, as the 
publishers Hatter themselves, a deficiency which is 
felt by every artist and manufacturer, whose processes 
involve the principles of chemical science, the want 
of a Systematic Work which should embody the most 
recent improvements in the chemical arts and manu- 
factures, whether derived from the researches of sci- 
entific men, or the experiments and observations of 
the operative manufacturer and artisans themselves. 



CHEXICAZ* MAJVTPULATION. Instruction 
to Students on tile Methods of performs 
ins Experiments cf Demonstration or 
Research, with accuracy and success. By 
MICHAEL FARADAY, F. R. S. First 
American, from Hie second London edi- 
tion, with Additions by J. !£.. MITCHELL, 
M.D. 

" After a very careful perusal of this work, we strenu- 
ously recommend it. as containing the most com; 
excellent instructions for conducting chemical e.xperi 
ments. There are few persons, however great their ex- 
perience, who may not sain information in many impor- 
tant particulars ; and for ourselves, we beg most unequiv- 
ocally to acknowledge ihat we have acquired many new 
and important hints on subjects of even every-day occur- 
rence." — Philosophical Mag. 

"A work hitherto exceedingly wanted in the labora- 
tory, equally useful to the proficient and to tlv student, 
and eminently creditable to the industry and skill of the 
author, and to the school whence it emanates."' — Jour- 
nal of Science and Arts. 



GEOLOGICAL MANUAL, by H. T. De la 
Beche, F. R. S., F. G. S., Mem. Geol. Soc. 
of France. In 8vo. With 104 Wood Cuts. 



ELEMENTS of PHYSICS, or NATURAL 
PHILOSOPHY, GENERAL and MEDI- 
CAL, explained independently of TECH- 
NICAL MATHEMATICS, and containing 
New Disquisitions and Practical Sugges- 
tions. By Neill Arnott, M. D. Second 
American from the fourth London edition, 
with Additions by Isaac Hays, M. D. 

" Dr. Anion's work has done for Physics as much as 
Locke's ESssay did for the science of mind." — London Uni- 
versity Magazine. 

" We may venture to predict that it will not be surpass- 
ed." — Times. 

" Dr. A. has not done less for Physics than Blackstone 
did for the Law." — Morning Herald. 

" Dr. A. has made Natural Philosophy as attractive as 
Button made Natural History." — French Critic. 

" A work of the highest class among the productions of 
mind." — Courier. 

" We regard the style and manner as quite admirable." 
— Morning Chronicle. 

" As interesting as novel-reading." — Jlthenaum. 

"Never did philosophic hand wield a pen more calcu- 
lated to win men to be wise and good."— Edinburgh Gb- 
scrccr. 

" Of this valuable, or we might say, invaluable work, 
a second edition has been speedily demanded by the pub- 
lic voice." — Lit. Gaz. 

A FLORA of NORTH AMERICA, with 
108 colored Plates. By W. P. C. Barton, 
M. D. In 3 vols. 4to. 

ARNOTT'S ELEMENTS of PHYSICS. 

Vol. II. Parti. Containing Light and Heat. 

" Dr. Arnott's previous volume lins been so well rec liv- 
ed, that it has almost banished all th ! flimsy productions 
called popular, which falsely pretend to strip science of 
it> mysterious and repulsive aspect, and to exhibit a holy- 
day apparel'. The success of such a work snows most 
clearly that it is plain, but sound knowledge which the 
public want." — Monthly Review. 

AMERICAN ORNITHOLOGY, or NATU- 
RAL HISTORY of BIRDS, inhabiting 
the UNITED STATES, by Charles Lu- 
cien Bonaparte; designed as a continua- 
tion of Wilson's Ornithology, Vols. I. IL 
and III. 

%* Gentlemen who possess Wilson, ant) are de- 
sirous of rendering the work complete, arc informed 
that tho edition of this work is very small, and that 
bnt a very limited number of copies remain unsold. 
Vol. IV. in the Press. 

A DISCOURSE o.v the REVOLUTIONS of 
the SURFACE of the GLOBE and the 
Changes thereby prodvckd in the ANI- 
MAL KINGDOM. By Baron G. Ouvier. 
Translated from the French, with Illustra- 
tions and a Glossary. In 12mo. With Plates. 

* One of the most scientific and important, yet plain 

and lucid works, which adorn the age Here is vast 

aid to the reader interested in the study of nature, and 
the lights which reason and Investigation haw thrown 
upon the formation of the universe. "— JVc:9 Monthly Mag. 
auvc. 



PHYSIOLOGICAL. MEDICINE AM) ANATOMY. 



HISTORY OF CHRONIC PHLEGMASIA, 
OR INFLAMMATIONS, founded on Clin- 
ical Experience and Pathological Anatomy, 
exhibiting a View of the different Varieties 
and Complications of these Diseases, with 
their various Methods of Treatment. By 
F. J. V. Broussais, M. D. Translated from 
the French of the fourth edition, by Isaac 
Hays, M. D. and R. Eglesfeld Griffith, 
M. D. Members of the American Philosoph- 
ical Society, of the Academy of Natural 
Science, Honorary Members of the Phila- 
delphia Medical Society, &c. &c. In 2 vols. 
8vo. 

EXAMINATION OF MEDICAL DOC- 
TRINES AND SYSTEMS OF NOSOL- 
OGY, preceded by Propositions containing 
the Substance of Physiological Medicine, 
by F. J. V. Broussais, Officer of the Royal 
Order of the Legion of Honor ; Chief Phy- 
sician and First Professor in the Military 
Hospital for Instruction at Paris, &c. Third 
edition. Translated from the French, by 
Isaac Hays, M. D. and R. E. Griffith, 
M. D. In 2 vols. 8vo. In the press. 

A TREATISE ON PHYSIOLOGY, Applied 
to Pathology. By F. J. V. Broussais, M. D. 
Translated from the French, by Drs. Bell 
and La Roche. 8vo. Third American edi- 
tion, with additions. 

"We cannot too strongty recommend tlie present work 
to the attention of our readers, and indeed of all those 
who wish to study physiology as it ought to be studied, 
in its application to the science of disease." " We may 
safely say that he has accomplished his task in a most 
masterly manner, and thus established his reputation as 
a most excellent physiologist and profound pathologist." 
— North American Med. and Surg. Journ. Jan. 1827. 

THE PRINCIPLES AND PRACTICE OF 
MEDICINE. By Samuel Jackson, M. D. 

Adjunct Professor of the Institutes and Prac- 
tice of Mecicine in the University of Penn- 
sylvania. 8vo. 

THE PRACTICE OF MEDICINE, upon the 
Principles of the Physiological Doctrine. 
By J. G. Coster, M. D. Translated from 
the French. 

Aw EPITOME of the PHYSIOLOGY, 
GENERAL ANATOMY, and PATHOL- 
OGY of BICHAT. By Thomas Hender- 
son, M. D. Professor of the Theory and 
Practice of Medicine in Columbia College, 
Washington City. 8vo. 

"The Epitome of Dr. Henderson ought and must find a 
place in the library of every physician desirous of useful 
knowledge for himself, or of being instrumental in im- 
parting it to others, whose studies he is expected to super- 
intend."— JV. A. Med. and Surg. Journ. No. 15. 

A TREATISE on FEVER, considered in the 
spirit of the new medical Doctrine. By J. 
B. Boisseau. Translated from the French. 
In the Press. 



DIRECTIONS for MAKING ANATOMnl-s 
ICAL PREPARATIONS, formed on theft* 1 
basis of Pole, Marjolin and Breschet, andjV. 
including the new method of Mr. Swan, by 
Usher Parsons, M. D. Professor of Anatomy 
and Surgery. In 1 Vol. 8vo. with plates. j 

A TREATISE o^ PATHOLOGICAL 
ANATOMY. By William E. Horner, 
M. D. Adj. Prof, of Anatomy in the Univer- : 
sity of Pennsylvania. 

"We can conscientiously commend it to the members of 
the profession, as a satisfactory, interesting, and instruct 
tive view of the subjects discussed, and as well adapted 
to aid them in forming a correct appreciation of the dis- 
eased conditions they are called on to relieve." — American 
Journal of the Medical Sciences, JVo. 9. 



By the same Author. 

A TREATISE on SPECIAL and GENERAL 
ANATOMY. Second edition, revised and 
corrected, in 2 Vols. 8vo. 

LESSONS in PRACTICAL ANATOMY, 
for the use of Dissectors. 2d edition, in 1 
Vol. 8vo. 

SYSTEM of ANATOMY, for the use of Stu- 
dents of Medicine. By Caspar Wistar. 
Fifth edition, revised and corrected, by W. 
E. Horner, Adjunct Professor of Anatomy 
in the University of Pennsylvania. In 2 
Vols. 8vo. 

ELEMENTS of GENERAL ANATOMY 

or a description of the Organs comprising 
the Human Body. By P. A. Beclard, Pro- 
fessor of Anatomy to the Faculty of Medi- 
cine at Paris. Translated by J. Togno. 

TREATISE on SURGICAL ANATOMY.! 
By Abraham Colles, Professor of Anatomy 
and Surgery, in the Royal College of Sur- 
geons in Ireland, &c. Second American 
edition, with notes by J. P. Hopkinson, De- 
monstrator of Anatomy in the University of 
Pennsylvania, &c. &c. 

A TREATISE on PATHOLOGICAL 
ANATOMY. By E. Geddings, M. D. Pro- 
fessor of Anatomy in the Medical College of 
South Carolina. In 2 vols. Svo. (In the 
press.) 

ELEMENTS OF MYOLOGY. By E. Ged- 
dings, M. D. illustrated by a series of beau- 
tiful Engravings of the Muscles of the Hu- 
man Body, on a plan heretofore unknown 
in this country. In the press. 
This work, in addition to an ample and accurate 
description of the general and special anatomy of the 
muscular system, will comprise illustrations of the 
subject from comparative anatomy and physiology, 
with an account of the irregi^tfiities, \ ariations and 
anomalies, observed by the various ancient and mod- 
ern anatomisis, down to the present time. 



MEDICINE AND SURGERY. 









\ TREATISE on FEVER. By Southwoop 
Smith, M. D., Physician to the London 
Fever Hospital. 

" No work lias been more lauded by the Reviews than 
lithe Treatise on Fevers, by Southwooii Smith. Dr. John 
ton, the editor of the Medico-Cbirttrgical Review, says, 
It is the best we have ever perused on the subject of 
fever, and in our conscience, we believe it the best that 
jjever flowed from the pen of physician in any age or in 
''jany country.' " — Am. .Med. Journ, 

IAn ESSAY on REMITTENT and INTER- 
MITTENT DISEASES, including generic- 
ally Marsh Fever and Neuralgia — compris- 
ing under the former, various Anomalies, 
Obscurities, and Consequences, and under a 
new systematic View of the latter, treating 
of Tic Douloureux, Sciatica, Headache, 
Ophthalmia, Toothache, Palsy, and many 
other Modes and Consequences of this gene- 
ric Disease ; by John Macculloch, M. D., 
F. R. S. &c. &c. 

'In rendering Dr. Macculloch's work more accessible 
to the profession, we are conscious that we are doing the 
I state some service." — Med. Cltir. Review. 

We most strongly recommend Dr. Macculloch's trea- 
tise to the attention of our medical brethren, as present- 
ing a most valuable mass of information, on a most im- 
portant subject."— JV. A. Med. and Surg. Journal. 

A PRACTICAL SYNOPSIS OF CUTANE- 
OUS DISEASES, from the most celebrated 
Authors, and particularly from Documents 
afforded by the Clinical Lectures of Dr. 
Biett, Physician to the Hospital of St. Louis, 
Paris. By A. Cazenave, M. D. and H. E. 

SCHEDEL, M. D. 

" We can safely recommend this work to the attention 
of practitioners as containing much practical infonna- 
I tion, not only on the treatment, but also on the causes 
of cutaneous affections, as b<:ing in fact the best treatise 
on diseases of the skin that has ever appeared." — Ameii- 
canJoumalof tlie Medical Sciences, J\"o. 5. 

SURGICAL MEMOIRS OF THE RUSSIAN 
CAMPAIGN. Translated from the French 
of Baron Larrey. 
LECTURES ON INFLAMMATION, exhib- 
iting a view of the General Doctrines, Pa- 
thological and Practical, of Medical Sur- 
gery. By John Thompson, M. D., F. R. S. E. 
Second American edition. 
THE INSTITUTES AND PRACTICE OF 
SURGERY ; being the Outlines of a Course 
of Lectures. By W. Gibson, M. D. Profes- 
sor of Surgery in the University of Pennsyl- 
vania. 3d edition, revised, corrected, and 
enlarged. In 2 vols. 8vo. 
PRINCIPLES OF MILITARY SURGERY, 
comprising Observations on the Arrange- 
ments, Police, and Practice of Hospitals, 
and on the History, Treatment, and Anoma- 
lies of Variola and" Syphilis ; illustrated with 
cases and dissections. By John Hennen, 
M. D., F. R. S. E. Inspector of Military 
Hospitals — first American from the third 
London edition, with the Life of the Author, 
by his son, Dr. John Hennen. 
"The value of Dr. Hennen's work is too well appreci- 
ated to need any praise of ours. We were only required 
then, to brin<r the third edition before the*notice of our 
readers; and having done this, we shall merely add, that 
the volume merits a place in every library, and that no 
military surgeon ought to be without it." — Medical Oai 

'JY'J. HJ I in . ■! '« "ill ill J I I I 



AMERICAN JOURNAL, OF THE MEDICAIi 

SCIENCES. 

Published Quarterly. 

And supported by the most distinguished Physicians 
in the United States, among which are Professors 
Bigelow, Channing, Chapman, Coxe, De Butis, De- 
wees, Dickson. Dudley, Francis, Gibson, Hare, 
Henderson, Horner, Hosack, Jackson, Macneven, 
Moil, Mussey, Physick, Potter, Sewall, Warren, 
and Worthington; Drs. Daniell, Drake, Emerson, 
Feam, Geddings, Griffith, Hale, Hays, Hayward, 
Ives, Jackson, Moultrie, Ware, and Wright. It is 
published punctually on the first of November, 
February, May, and August. Each No. contains 
about 280 large 8vo. pages, and one or more plates 
—being a greater amount of matter than is fur- 
nished by any other Medical Journal in the United 
Slates. Price $5 per annum. 

The following Extracts show the estimation 
in which this Journal is held in Europe : — 

"Several of the American Journals are before us. * * * 
Of these the American Journal of the Medical Sciences 
is by far the butter periodical ; it is, indeed, the best of the 
transatlantic medical publications; and, to make a com- 
parison nearer home, is in most respects superior to the 
gn at majority of European works of the same descrip- 
tion."— The Lancet, Jan. J831. 

" We need scarcely refer our esteemed and highly emi- 
nent cotemporary, [ The American Journal of the Medical 
Sciences,] from whom we quote, to our critical remarks 
on the opinions of our own countrymen, or to the princi- 
ples which influence us in the discharge of our editorial 
duties." " Our copious extracts from his unequalled pub- 
lication, unnoticing multitudes of others which come be- 
fore us, are the best proof of the esteem which we enter- 
tain for his talents and abilities."— London Medical and 
Surgical Journal, March, lb30. 

"The American Journal of the Medical Sciences is one 
of the most complete and best edited of the numerous 
periodical publications of the United States." — Bulletin 
des Sciences Medicales, Tom. XIV. 

PATHOLOGICAL and PRACTICAL RE- 
SEARCHES on DISEASES of the BRAIN 
and SPINAL CORD. By John Abercrom- 
bie, M. D. 

"We have bore a work of authority, and one which 

docs credit to the author and his country." — North Amer. 
Mid and Surg. Journal. 

By the same Author. 
PATHOLOGICAL and PRACTICAL RE- 
SEARCHES on DISEASES of the STO- 
MACH, the INTESTINAL CANAL, the 

LIVER, AND OTHER VISCERA OF THE 

ABDOMEN. 

"We have now closed a very long review of a very 
valuable work, and although we have endeavored to con- 
dense i it.o our pages a great mass of important matter, 
we fi el that our author has not yet received justice." — 
Medico- Chi rurgical Review. 

A RATIONAL EXPOSITION of the 
PHYSICAL SIGNS of DISEASES of 
the LUNGS and PLEURA; Illustrating 
their Pathology and facilitating their diag- 
nosis. By Charles J. Williams, M. D. In 
8vo. with plates. 
"If we are not greatly mistaken, it will lead to a better 

understanding, and a more correct estimate of the value 

of auscultation, than any thing that has yet appeared." 

— Am. Med. Journal. 

MANUAL of the PHYSIOLOGY of MAN; 
or a concise Description of the Phenomena 
of his Organization. By P. Htjtin. Trans- 
lated from the French,, with Notes, by J. 
Togno. In 12rno. 



MEDICINE. 



The PRACTICE of PHYSIC. By W. P. 
Dewees, M. D. Adjunct Professor of Mid- 
wifery, in the University of Pennsylvania, 
2 Vols. 8vo. 

"We have no hesitation in recommending it as deci- 
dedly one of the best systems of medicine extant. The 
tenor of the work in general reflects the highest honor on 
Dr. Dewees's talents, industry, and capacity for the exe 
cution of the arduous task which he had undertaken. It 
is one of the most able and satisfactory works which mod 
em times have produced, and will be a standard authori 
ty." — London Med. and Surg. Journal, Aug. 1830. 

DEWEES on the DISEx\SES of CHIL- 
DREN. 4th ed. In 8vo. 
. The objects of this work are, 1st, to teach those who 
have the charge of children, either as parent or guar 
dian, the most approved methods of securing and im 
proving their physical powers. This is attempted by 
pointing out the duties which the parent or the guar 
dian owes for this purpose, to this interesting, but 
helpless class of beings, and the manner by which 
their duties shall be fulfilled. And 2d, to render 
available a long experience to these objects of our 
affection when they become diseased. In attempting 
this, the author has avoided as much as possible 
" technicality ;" and has given, if he does not flatter 
himself too much, to each disease of which he treats, 
its appropriate and designating characters, with a 
fidelity that will prevent any two being confounded 
together, with the best mode of treating them, that 
either his own experience or that of others has sug- 
gested. 

DEWEES on the DISEASES of FEMALES. 
3d edition, with Additions. In 8vo. 

A COMPENDIOUS SYSTEM OF MID- 
WIFERY; chiefly designed to facilitate the 
Inquiries of those who may be pursuing this 
Branch of Study. In 8vo. with 13 Plates. 5th 
edition, corrected and enlarged. By W. P. 
Dewees, M. D. 

The ELEMENTS OF THERAPEUTICS 
and MATERIA MEDICA. By N. Chap 
man, M. D. 2 vols. 8vo. 5th edition, cor 
rected and revised. 

MANUAL of PATHOLOGY: containing 
the Symptoms, Diagnosis, and Morbid Char- 
acter of Diseases, &c. By L. Martinet. 
Translated, with Notes and Additions, by 
Jones Quain. Second American Edition, 
12mo. 

" We strongly recommend M. Martinet's Manual to the 
profession, and especially to students; if the latter wish 
to study diseases to advantage, they should always have 
it at hand, both when at the badside of the patient, and 
when making post mortem examinations." — American 
Journal of the Medical Sciences, No. /. 

CLINICAL ILLUSTRATIONS of FEVER, 

comprising a Report of the Cases treated at 
the London Fever Hospital in 1828-29, by 
Alexander Tweedie, M. D., Member of the 
Royal College of Physicians of London, &c. 
1 vol. 8vo. 

"In short, the present work, concise, unostentatious 
as it is, would have led us to think that Dr. Tweedie was 
a man of clear judgment, unfettered by attachment to 
any fashionable hypothesis, that he was an energetic but 
judicious practitioner, and that, if he did not dazzle his 
readers with the brilliancy of theoretical speculations, he 
would command their assent to the solidity of his didac- 
tic precepts." — Med. Chir. Journal. 



The ANATOMY, PHYSIOLOGY, and DIS- 
EASES of the TEETH. By Thomas Bell,' 
F.R.S., F.L.S. &c. In 1 vol. 8vo. With Plates. 

"Mr. Bell has evidently endeavored to construct a 
work of reference for the practitioner, and a text-book 
for the student, containing a "plain and practical digest 
of the information at present possessed on the subject,' 
and results of the author's own investigations and expe- 
rience.' " * * * "We must now take leave of Mr Bell, 
whose work we have no doubt will become a class-book 
on the important subject of dental surgery." — Medico-Chi- 
rurgical Review. 

" We have no hesitation in pronouncing it to be the 
best treatise in the English language." — North American 
Medical and Surgical Journal, No. 19. 

AMERICAN DISPENSATORY. Ninth 
Edition, improved and greatly enlarged. By 
John Redman Coxe, M. D. Professor of Ma- 
teria Medica and Pharmacy in the Univer- 
sity of Pennsylvania. In 1 vol. 8vo. 
%* This new edition has been arranged with spe- 
cial reference to the recent Pharmacopoeias, published : 
in Philadelphia and New- York. 

ELLIS' MEDICAL FORMULARY. The 

Medical Formula^, being a collection of , 
prescriptions derived from the writings and 
practice of many of the most eminent Phy- 
sicians in America and Europe. By Benjamin 
Ellis, M. D. 3d. edition. With Additions. 

"We would especially recommend it to our brethren in 
distant parts of the country, whose insulated situations 
may prevent them from having access to the many autho- 
rities which have been consulted in arranging the mate- 
rials for this work." — Phil. Med. and Phys. Journal. 

MANUAL of MATERIA MEDICA and 
PHARMACY. By H. M. Edwards, M. D. 
and P. Vavasseur, M. D. comprising a con- 
cise Description of the Articles used in 
Medicine; their Physical and Chemical 
Properties ; the Botanical Characters of the 
Medicinal Plants ; the Formula) for the Prin- 
cipal Officinal Preparations of the American, 
Parisian, Dublin, &c. Pharmacopoeias ; with 
Observations on the proper Mode of combin- 
ing and administering Remedies. Trans- 
lated from the French, with numerous Ad- 
ditions and Corrections, and adapted to the 
Practice of Medicine and to the Art of Phar- 
macy in the United States. By Joseph Tog- 
no, M. D. Member of the Philadelphia Med- 
ical Society, and E. Dtjrand, Member of the 
Philadelphia College of Pharmacy. 
"It contains all the pharmaceutical information that 
the physician can desire, and in addition, a larger mass of 
information, in relation to the properties, &c. of the dif- 
ferent articles and preparations employed in medicine, 
than any of the dispensatories, and we think will entirely 
supersede all these publications in the library of the^Ay- 
sician." — Am. Journ. of the Medical Sciences. 

MEMOIR on the TREATMENT of VENE- 
REAL DISEASES without MERCURY, 

employed at the Military Hospital of the 
Val-de-Grace. Translated from the French 
of H. M. J. Desruelies, M. D. &c. To which 
are added, Observations by G. J. Guthrie, I 
Esq. and various documents, showing the | 
results of' this Mode of Treatment, in Great 
Britain, France, Germany, and America. 
1 vol. 8vo. 



PREPARING FOR PUBLICATION 

BY CAREY & LEA, 

CYCLOPEDIA 



PRACTICAL MEDICINE; 

COMPRISING 

TREATISES ON THE NATURE AND TREATMENT OF DISEASES, 
MATERIA MEDICA AND THERAPEUTICS, 
MEDICAL JURISPRUDENCE, &c. 



JOHN FORBES, M.D. F.R.S. 

Physician to the 
Chichester Infirmary, &c. 



EDITED EY 

ALEXANDER TWEED IE, M.D. 

Physician to the 

London Fever Hospital, &c. 



JOHN CONOLLY, M. D. 

Professor of Medicine in the 
London University ,&c. 



WITH THE ASSISTANCE OF THE FOLLOWING PHYSICIANS 

JAMES APJOHN, M.D. M. R. I. A. Professor of THOMAS HANCOCK, M.D Liverpool, Member 
Chemistry to the Royal College of Surgeons in Ire- 
land. 

JAMES L. BARDSLEY, M.D. Physician to the 
Manchester Royal Infirmary, Dispensary, &c. 

EDWARD BARLOW, M. D. Physician to the Bath 
United Hospital and Infirmary. 

R. H. BRABANT, M. D. Devizes. 

JOSEPH BROWN, M. D. Physician to the Sunder- 
land and Bishopwearmouth Infirmary. 

THOMAS H. BURDER, M. D. Member of the Royal 
College of Physicians, London. 

JOHN BURNE, M. D. Physician to the Carey-street 
Dispensarv. 

H. W. CARTER, M.D. F. R. S. E. Fellow of the 
Royal College of Physicians, London, Physician to 
the Kent and Canterbury Hospital. 

JOHN CHEYNE, M. D. F. R. S. E. M. R. I. A. 
Physician-General to the Forces in Ireland, &c. &c. 

JAMES CLARK, M. D. Physician to St. George's 
Infirmarv, &c. &c. 

JOHN CLEN DINNING, M. D. Fellow of the Royal 
College of Physicians, London. 

JOHN CRAMPTON, M.D. M.R.I. A. King's Pro- 
fessor of Materia Medica, Physician to Stevens's 
Hospita', &c. &c. Dublin. 

ANDREW CRAWFORD, M. D. Physician to the 
Hampshire Countv Hospital, Winchester. 

WILLIAM CUMIN, M. D. Glasgow. 

JAMES CUSACK, M.B. Steevens' Hospital, Dublin 

JOHN DARWALL, M. D. Physician to the General 
Dispensary, Birmingham. 

D. D. DAVIS, M. D. M.R. S. L. Professor of M 
wifery in the London University. 

JOHN ELLIOTSON, M.D. F.R.S. Physician to 

I St. Thomas's Hospital. 
R.J. GRAVES, M.D. M.R.I. A. Kino's Professo 

| of the Institutes of Medicine, Honorary Fellow of 
the King's and Queen's College of Physicians, Phy- 
sician to the Meath Hospital and County of Dublin 
Infirmarv. 
GEORGE GREGORY, M. D. Physician to the Small- 
Pox Hospital. 
MARSHALL HALL, M.D. F.R. S. E. Member of 
the Roval College of Physicians, London, &c. &c. 



of the Royal College of Physicians, London 
CHARLES HASTINGS, M. D. Physician to the 

Worcester General Infirmary. 
BISSET HAWKINS, M. D. Fellow of the Royal 
College of Phvsicians, Professor of Materia Medica 
and Therapeutics in King's College, Dublin. 
HOPE, M. D. Member of the Royal College of 
Physicians, London. 

ARTHUR JACOB, M.D. M.R. I. A. Professor of 
Anatomy to the Royal College of Surgeons in Ireland. 

ROBERT LEE, M. D. F. R. S. Physician to the 
British Lying-in Hospital. 

CHARLES LOCOCK, M. D. Physician to the West- 
minster General Lying-in Hospital, &c. &c. 

H. MARSH, M. D. M.R. I. A. Professor of the Prin- 
ciples and Practice of Medicine to the Royal College 
of Surgeons in Ireland, &c. Dublin. 

JONES QUAIN, M. B. L-cfurer on Anatomy and 
Physiology in the Medical School, Aldersgate-Street. 

J. C. PRICHARD, M. D. F. R. S. Physician to the 
Infirmary and to St. Peter's Hospital, Bristol.. 

ARCHIBALD ROBERTSON, M. D. Physician to 
the Northampton General Infirmary. 

P. M. ROGET, M.D. Sec. R. S. Consulting Physi- 
cian to the Queen Charlotte's Lying-in Hospital and 
to the Northern Dispensary, &c. &c. 

JOHN SCOTT, M.D. Edinburgh. 

WILLIAM STOKES, M. D. Physician to the Meath 
Hospital. 

WILLIAM STROUD, M. D. Physician to the North- 
ern Dispensary. 

A. T. THOMSON, M. D. F. L. S. Professor of .Ma- 
teria Medica in the London University. 

THOMAS THOMSON, M.D. F.R.S. L. & E. Re- 
gius Professor of Chemistry in the University of Glas- 
gow, cVc. Ac. 

T. J. TODD, M. D. Physician to the Dispensary, 
Brighton. 

RICHARD TOWNSEND, A. B. M. D. M. R. I. A. 
Fellow of King and Queen's College of Physicians, 
Dublin. 

CHARLES J. B. WILLIAMS, M.D. London. 
&c. &c, &c. 



To adant the above work to the wants of this country, the publishers have engaged the assistance 
of many of our most eminent physicians, and they pledge themselves that no exertion shall he spared 
to render it worthy of patronage. It will be published in monthly numbers, pjice 50 cts. 112 pp. each 



I 



CYCLOPiEDIA OF PRACTICAL MEDICINE. 

The want of a comprehensive work on subjects connected witf 
Practical Medicine including Pathology and Pathological Anat' 
omy, is one which has long existed in this country. The Medica 
Dictionaries heretofore published, and the Systems of Medicine ii 
the hands of the student, may be said, without invidiousness, td 
fall very far short of presenting the English reader with such t 
compendious survey of the actual state of British and Foreign 

('Medicine as is absolutely required by him. Some of them are toc 3 - 
limited and too superficial in their character ; others are too volu- 1 
minous, too intricate in their arrangement, and too indiscriminate 1 ' 
in their contents; and all are open to the serious objection of fail 
ing to represent the improvements and discoveries by which the 
scientific labors of the members of the medical profession, in vari- 
ous parts of the world, ha.ve been rewarded since the commence- 
ment of the present century. 

It is the object of the Cyclopaedia of Practical Medicine tOi 
supply these deficiencies, and to meet the acknowledged wants of 
the medical reader. Such ample arrangements have been made] 
| for effecting these important objects, as enable the Editors to las 
J before the public the nature and plan of a publication in which) 
they have endeavored, by dividing the labor of a work including 
subjects of great diversity, and all of practical importance ; by 
combining the valuable exertions of several contributors already] 
known to the medical public ; by excluding mere technical and 1 
I verbal explanations, and all superfluous matter; and by avoiding:] 
multiplied and injudicious divisions; to furnish a book which willjl 
be comprehensive without diffuseness, and contain an account of 
whatever appertains to practical medicine, unembarrassed by dis- 
quisitions and subjects extraneous to it. 

In pursuance of this design, every thing connected with what is 
commonly called the Practice of Physic will be fully and clearly 
explained. The subject of Pathology will occupy particular at- 
tention, and ample information will be given with relation to Pa- 
thological Anatomy. 

Although the excellent works already published on the subjects 
of Materia Msdica and Medical Jurisprudence can be so readily 
and advantageously consulted, as to make the details of those 
branches of science uncalled for in the Cyclopaedia, it belongs to 
the proposed plan to comprise such general notices of the applica- 
tion and use of medicinal substances as may be conveyed in a 



CYCLOPAEDIA OF PRACTICAL MEDICINE. 



I 



J : 



general account of each class into which they have been divided, 

s of Tonics, Narcotics, &c; and to impart, under a few heads, 

s Toxicology, Suspended Animation, Sic. such information con- 

tected with Medical Jurisprudence as is more strictly practical in 

Its character. 

It is almost unnecessary to say that a work of this description 

J vili form a Library of Practical Medicine, and constitute a most 

iesirable book of reference for the general practitioner, whose 

aumerous avocations, and whose want of access to books, afford 

)'iim little time and opportunity for the perusal of many original 

orks, and who is often unable to obtain the precise information 

J Miich he requires at the exact time when he is in greatest need of it. 

lr ' The Student of Medicine, who is attending lectures, will, also, 
tff\v means of this work, be enabled, whatever order the lecturer 
jnay follow, to refer, without difficulty, to each subject treated of 
in the lectures of his teacher; and it is presumed that Lecturers 
::i Medicine will see the advantage of recommending to their 
Upils a work of highly respectable character, the composition of 
priginal writers, and which, it is hoped, will neither disappoint the 
Advanced student by its brevity and incompleteness, nor perplex 
hose commencing their studies by an artificial arrangement. 

But, whilst the Editors have felt it to be their duty to prepare a 
afe and useful book of reference and text-book, it would be doing 
Injustice to those by whose co-operation they have been honored, 
hot to avow that they have also been ambitious to render the 
fvork acceptable and interesting to readers who have leisure and 
inclination to study what may be termed the Philosophy of Medi- 
cine: whatever is truly philosophical in medicine being also useful, 
Although the application of the science to the art requires much re- 
flection and sound judgment. — For the assistance of those who desire 
to pursue a regular course of medical reading, ample directions 
will be given when the work is completed; and for those who may 
he anxious to prosecute any particular subject to a greater extent 
than the limits of the Cyclopaedia permit, a list will be given, in an 
Appendix, of the best works relating to each. 

The means of accomplishing an undertaking of the importance 
lof which the Editors are fully sensible, will, doubtless, be appre- 
ciated after an inspection of the list of contributors who have 
already promised their co-operation. It is, of course, desirable 
ithat a work of this kind should be characterized by unity of de- 



CYCLOPEDIA OF PRACTICAL 3IEDICINE, 






sign, but, at the same time, as each author will! generally speak- 
ing, contribute his knowledge and his opinions on the subjects 
which have occupied his chief attention, the superiority of the 
whole performance to any thing which the mere labor of compila- 
tion could accomplish will be unquestionable. To each important 
article the name of the author will be appended. 

The acknowledged want of such a publication, already alluded 
to, and the extensive encouragement which Dictionaries of a much 
greater extent have met with in Fraxce and Germany, although 
some of them are very unequal as regards the value of different 
parts, and encumbered with much that is absolutely useless, afford 
sufficient reason to hope for the success of a work in which what 
is valuable will, as much as possible, be separated from what is 
merely calculated to distract the attention, and to frustrate the 
inquiry, of those who study the science of medicine with a view 
of regulating and improving its practice. 

In order to insure this success, it is the desire, and will be the 
endeavor, of the Editors to make the Cyclopaedia of Practical 
Medicixe not only obviously useful to those for whom it is more 
immediately intended, but so creditable to British Medical Sciexce 
as to deserve and to obtain the patronage of all classes of the 
Medical Profession. 



Ix the American edition, all interesting details on the subjects 
of Materia Medica and Medical Jurisprudexce. omitted m the 
original, will be supplied. — Much new matter in relation to A3ieri- 
cax Surgery and Medical Practice will be introduced ; and for 
this ample materials have been promised. — Full explanations will 
be giveo of all medical terms, especially those which modern dis- 
coveries have introduced into the nomenclature of the science, and 
without a knowledge of which, many of the works of the present 
day are almost unintelligible. — At the termination of each article 
the most copious references will be given to the best writers on 
the subject, so as to enable the student who desires it, to pursue 
his investigations with the least trouble and the greatest advan- 
tao-p. — Finally, the whole work will be carefully revised, and such 
additions made as may tend to increase its value, and to render it, 
what it is desired it should be^l^ complete Library of the Medical 

SciEXCES. - 



LIBRARY OF CONGRESS 



111 

021 067 345 3 



